1029 The Utility of the Baveno VI Criteria in a Safety Net Hospital

Abstract

INTRODUCTION: Patients with liver cirrhosis are at risk for life-threatening hemorrhage from esophageal varices. Variceal hemorrhage can be prevented with medical and endoscopic therapies, so identifying patients through a screening process is paramount. Traditionally, screening was offered to all patients with cirrhosis; however, not all patients with cirrhosis are at the same risk to develop variceal hemorrhage. Using the Baveno VI criteria, cirrhotic patients with low risk for esophageal varices can be identified and spared the risks associated with invasive endoscopic screening. Previous studies have not evaluated these criteria in a safety net hospital population. METHODS: We enrolled 75 patients with cirrhosis for a retrospective chart review. Inclusion criteria were F3-4 or F4 by transient elastography and esophagogastroduodenoscopy (EGD) within 12 months of the elastography procedure. RESULTS: Mean age was 58 years, 54.7% were male and 53% of patients identified as black, African-American, or Hispanic. 67% had hepatitis C, 16% had alcoholic liver disease, and 16% had non-alcoholic fatty liver disease. 42.6% of patients had obesity (BMI > 30) and 56% had metabolic syndrome. 21 patients met Baveno VI criteria and 12 had esophageal varices on upper endoscopy. 4 additional patients had esophageal varices, yet were not identified as a high risk patient per Baveno VI criteria. 16 patients in total had esophageal varices (21.3%). 11 had small esophageal varices (without high risk stigmata) and 5 had high risk varices requiring intervention (large varices or varices with high risk stigmata). For Baveno VI criteria predicting the presence of any varices, the sensitivity was 75% (12/16), specificity was 84.8% (50/59), positive predictive value was 57.1% (12/21), and the negative predictive value was 92.6% (50/54). Baveno VI criteria identified all patients with high risk varices (5/5). CONCLUSION: With a robust negative predictive value in a safety net hospital population, Baveno VI criteria seems to be an adequate method for identifying patients who can avoid screening endoscopy for esophageal varices.