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Non-Invasive Prediction of High-Risk Varices in Patients with Primary Biliary Cholangitis and Primary Sclerosing Cholangitis

Moctezuma-Velazquez, Carlos, MD, MSc1; Saffioti, Francesca, MD2,3; Tasayco-Huaman, Stephanie, MD4,5; Casu, Stefania, MD6; Mason, Andrew, MD, MBBS1; Roccarina, Davide, MD, PhD2; Vargas, Victor, MD4,5; Nilsson, Jan-Erick, MD1; Tsochatzis, Emmanuel, MD, PhD2; Augustin, Salvador, MD4,5; Montano-Loza, Aldo J., MD, PhD1; Berzigotti, Annalisa, MD, PhD6; Thorburn, Douglas, MD, PhD2; Genesca, Joan, MD, PhD4,5; Abraldes, Juan Gonzalez, MMSc1

American Journal of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 446–452
doi: 10.1038/s41395-018-0265-7

BACKGROUND: Baveno-VI guidelines recommend that patients with compensated cirrhosis with liver stiffness by transient elastography (LSM-TE) <20 kPa and platelets >150,000/mm3 do not need an esophagogastroduodenoscopy (EGD) to screen for varices, since the risk of having varices needing treatment (VNT) is <5%. It remains uncertain if this tool can be used in patients with cholestatic liver diseases (ChLDs): primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). These patients may have a pre-sinusoidal component of portal hypertension that could affect the performance of this rule. In this study we evaluated the performance of Baveno-VI, expanded Baveno-VI (LSM-TE <25 kPa and platelets >110,000/mm3), and other criteria in predicting the absence of VNT.

METHODS: This was a multicenter cross-sectional study in four referral hospitals. We retrospectively analyzed data from 227 patients with compensated advanced chronic liver disease (cACLD) due to PBC (n = 147) and PSC (n = 80) that had paired EGD and LSM-TE. We calculated false negative rate (FNR) and number of saved endoscopies for each prediction rule.

RESULTS: Prevalence of VNT was 13%. Baveno-VI criteria had a 0% FNR in PBC and PSC, saving 39 and 30% of EGDs, respectively. In PBC the other LSM-TE-based criteria resulted in FNRs >5%. In PSC the expanded Baveno criteria had an adequate performance. In both conditions LSM-TE-independent criteria resulted in an acceptable FNR but saved less EGDs.

CONCLUSIONS: Baveno-VI criteria can be applied in patients with cACLD due to ChLDs, which would result in saving 30–40% of EGDs. Expanded criteria in PBC would lead to FNRs >5%.

1Liver Unit, Division of Gastroenterology, CEGIIR, University of Alberta, Edmonton, Canada;

2UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital, London, United Kingdom;

3Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy;

4Liver Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain;

5Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain;

6Bern University Hospital, Bern, Switzerland.

Correspondence: Joan Genesca, MD, PhD. E-mail: or Juan Gonzalez Abraldes, MMSc. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at

These authors contributed equally: Joan Genesca, Juan Gonzalez Abraldes.

Received April 17, 2018

Accepted July 21, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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