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.
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.
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.
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: firstname.lastname@example.org or Juan Gonzalez Abraldes, MMSc. E-mail: email@example.com.
SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A52
These authors contributed equally: Joan Genesca, Juan Gonzalez Abraldes.
Received April 17, 2018
Accepted July 21, 2018