Screening and surveillance of oesophageal varices in patients with HCV‐positive liver cirrhosis successfully treated by direct‐acting antiviral agents

Abstract

Background & Aims: limited evidence is available to guide hepatologists regarding endoscopic surveillance of oesophageal varices (EV) in Hepatitis C Virus (HCV)-positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long-term prospective study on 427 HCV-positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs). Methods:Patients were divided into two groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favourable Baveno VI status) and Group 2 (335, 78.5%, unfavourable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow-up of 65.2 months according to Baveno VI recommendations.Results: About 4.3% of Group 1 patients showed baseline EV compared with 30.1% of Group 2 patients (p < .0001). No patients belonging to Group 1 without baseline EV developed EV at follow-up endoscopy compared with 6.5% in Group 2 patients (p = .02); 69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow-up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 (p = .001).Improvement in Baveno VI status was observed in 118/335 (35.2%, p < .0001) of Group 2 patients and among those without pre-therapy EV, none developed EV throughout the follow-up.

Long‐term endoscopic surveillance in HBV compensated cirrhotic patients treated with Tenofovir or Entecavir for 11 years

“…Viral suppression and ALT normalisation, leading to reduced intrahepatic inflammation and fibrosis regression, are the most relevant drivers of these favourable findings. Similar data have been recently shown also in DAA‐cured HCV compensated cirrhotics 29,33,34 . Overall, EV disappeared in 17.4% of patients over 3 years 29 …”

“…Similar data have been recently shown also in DAA-cured HCV compensated cirrhotics. 29,33,34 Overall, EV disappeared in 17.4% of patients over 3 years. 29 Our study provides a unique opportunity to also validate the recent Baveno recommendation in terms of endoscopic surveillance strategy in patients with HBV-related cirrhosis under long-term effective NUC.…”

Carvedilol Plus NUC for Patients With HBV-Compensated Cirrhosis Under Virological Suppression: A Randomized Open-Label Trial

“…While etiological treatment can alleviate PHT, the persistence or worsening of clinically significant PHT in patients with well-known etiology control is not negligible. Previous observational studies have shown that the addition of NSBB can reduce the progression rate of EV in patients with high-risk EV (23,24). However, these findings are based on observational data and lack head-to-head RCT studies.…”

“…However, these findings are based on observational data and lack head-to-head RCT studies. The evidence is very limited, particularly for small cases (23,25,26). Our study provides important evidence to further clarify the appropriate use of NSBB in patients with well-controlled etiology.…”