Expanded Baveno VI Criteria Research Articles

Is Transient Elastography Needed for Noninvasive Assessment of High-Risk Varices? The REAL Experience.

The Baveno VI consensus guidelines and an expanded algorithm suggest that transient elastography (TE) and platelet (PLT) count can be used to identify patients with cirrhosis who can avoid esophagogastroduodenoscopy (EGD). The primary aims of this study were to assess the ability of a simple algorithm, which uses only laboratory parameters, to predict medium/large esophageal varices (EV) in patients with hepatitis C virus (HCV) and cirrhosis from the Rete Sicilia Selezione Terapia-HCV (RESIST-HCV) cohort and to compare the performance of the algorithm with Baveno VI and Expanded Baveno VI criteria. The secondary aim was to assess the role of TE in ruling out large EV. In total, 1,381 patients with HCV-associated cirrhosis who had EGD and TE within 1 year of starting treatment with direct-acting antivirals were evaluated. Using multivariate logistic analysis, laboratory variables were selected to determine which were independently associated with medium/large EV to create the RESIST-HCV criteria. These criteria were tested in a training cohort with patients from a single center (Palermo) and validated with patients from the 21 other centers of the RESIST-HCV program (validation cohort). In the entire cohort, medium/large EV were identified in 5 of 216 patients (2.3%) using the Baveno VI criteria and 13 of 497 patients (2.6%) using the Expanded Baveno VI criteria. PLT count and albumin level were independently associated with medium/large EV. The best cut-off values were a PLT count greater than 120 × 10 cells/μL and serum albumin level greater than 3.6 g/dL; negative predictive values (NPVs) were 97.2% and 94.7%, respectively. In the training cohort of 326 patients, 119 (36.5%) met the RESIST-HCV criteria and the NPV was 99.2%. Among 1,055 patients in the validation cohort, 315 (30%) met the RESIST-HCV criteria and the NPV was 98.1%. Adding TE to the RESIST-HCV criteria reduced the avoided EGDs for approximately 25% of patients and the NPV was 98.2%. The "easy-to-use" RESIST-HCV algorithm avoids EGD for high-risk EV screening for more than 30% of patients and has the same performance criteria as TE. Using these criteria simplifies the diagnosis of portal hypertension.

The impact of sustained virological response (SVR) on the criteria used to rule out high risk esophageal varices (HRV) in HCV-related compensated advanced chronic liver disease (cACLD)

Background: Baveno VI criteria [platelet count (plt) >150 × 109/l and liver stiffness measurement (LSM) <20 KPa] to rule out high risk esophageal varices (HRV) in chronic advanced viral-related liver disease (cACLD) perform efficiently in viremic patients. Further refinements of these criteria [Expanded Baveno VI criteria (Plt110/LSM25), or Plt125/LSM25 criteria] maintain high accuracy sparing more endoscopies. The Plt150/MELD6 criteria are less accurate in viremic cACLD patients. How sustained virological response (SVR) achieved by direct-acting antivirals (DAA) impacts on such criteria is unknown. We assessed the performance of Expanded Baveno VI, Plt125/LSM25 and PLT150/MELD6 criteria, compared to the original Baveno VI criteria, to rule out HRV in 192 HCV-related cACLD patients with an SVR to DAAs.

From the Editor’s Desk…: October 2018

From the Editor’s Desk…: October 2018

Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis

Baveno VI and expanded Baveno VI criteria can avoid the need for esophagogastroduodenoscopy (EGD) to screen for varices needing treatment (VNT) in a substantial proportion of compensated patients with viral and/or alcoholic cirrhosis. This multicenter, cross-sectional study aims to validate these criteria in patients with compensated cirrhosis due to non-alcoholic fatty liver disease (NAFLD), accounting for possible differences in liver stiffness measurement (LSM) values between M and XL probes. We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within six months of a reliable LSM, measured by FibroScan® using M and/or XL probe. Baveno VI and expanded Baveno VI criteria were tested. The main variable used to optimize criteria was the percentage of endoscopies spared, keeping the risk of missing large VNT below a 5% threshold. LSM was measured by both M and XL probes (training set) in 314 patients, while only M or XL probe (validation sets) were used to measure LSM in 338 and 138 patients, respectively. In the training set, use of Baveno VI and expanded Baveno VI criteria reduced the number of EGD by 33.3% and by 58%, with 0.9% and 3.8% of large esophageal varices missed, respectively. The best thresholds to rule-out VNT were identified as platelet count >110,000/mm3 and LSM <30 kPa for M probe, and platelet count >110,000/mm3 and LSM <25 kPa for XL probe (NAFLD cirrhosis criteria). Thus, usage of NAFLD cirrhosis criteria would have led to an absolute reduction in the number of EGD screened patients of 34.7% and 10.5% with respect to Baveno VI and expanded Baveno VI criteria, respectively. The new NAFLD cirrhosis criteria, established for the FibroScan probe, can reduce the use of EGD for screening of VNT in NAFLD cirrhosis by more than half, with a chance of missing VNT below 5%. In non-alcoholic fatty liver disease-related compensated cirrhosis, the expanded Baveno VI criteria work better than the Baveno VI criteria for ruling out the presence of varices needing treatment, sparing unnecessary and invasive screening procedures. New diagnostic criteria for this patient group, based on liver stiffness measurement and platelet count, and optimized for the specific FibroScan® probe used, work better than both Baveno VI and expanded Baveno VI criteria. The accuracy of all non-invasive scoring criteria was lower in non-obese patients.

Tu1558 - An External Validation of the Baveno VI and Expanded Baveno VI Criteria on Attempting to Transform them into a One Stop Liver Shop

Tu1558 - An External Validation of the Baveno VI and Expanded Baveno VI Criteria on Attempting to Transform them into a One Stop Liver Shop

SAT-280 - Screening of esophagogastric varices: Performance of the “Expanded Baveno Vi criteria” and the “platelet 150/MELD 6” strategy in all etiology compensated advanced chronic liver disease

SAT-280 - Screening of esophagogastric varices: Performance of the “Expanded Baveno Vi criteria” and the “platelet 150/MELD 6” strategy in all etiology compensated advanced chronic liver disease

Validation of the Baveno VI and the expanded Baveno VI criteria to identify patients who could avoid screening endoscopy.

The Baveno VI and the expanded Baveno VI criteria were proposed to help identify patients who could safely avoid screening endoscopies for clinically significant varices among patients with compensated advanced chronic liver disease. However, these criteria require cross-validation, especially in Asian populations where the aetiologies of liver disease are different. A total of 1035 patients, including 282 patients with compensated advanced chronic liver disease of different aetiology, were analysed. The compensated advanced chronic liver disease was defined by liver stiffness measurement ≥10kPa, Child-Pugh class A and absence of prior liver decompensation. High-risk varix was defined as a grade ≥2 oesophageal varix, any varix with a red colour sign or gastric varices. High-risk varixs were present in 19.5% (55/282 patients) with compensated advanced chronic liver disease. Among compensated advanced chronic liver disease patients, the expanded criteria could spare more endoscopies (51.7%) than the original criteria (27.6%). However, the expanded criteria missed a greater number of high-risk varixs (6.8%) than the original criteria (3.8%). When stratified according to liver disease aetiology, the negative predictive values for the original Baveno VI criteria were 0.92, 1.00, 1.00 and 1.00, and the negative predictive values for the expanded criteria were 0.92, 0.96, 0.92 and 0.93 for hepatitis B, hepatitis C, alcohol and non-alcoholic fatty liver disease, respectively. High-risk varixs were rarely detected in patients without compensated advanced chronic liver disease (1.1%, 8/753 patients). In this Asian cohort study, the Baveno VI criteria were able to identify who could safely avoid screening endoscopy. The expanded Baveno VI criteria could spare more endoscopies but also could increase the odds of missing a high-risk varix.

Screening of esophagogastric varices: Performance of the “Expanded Baveno VI criteria” and the “platelet 150/MELD 6” strategy in all etiology compensated advanced chronic liver disease

Background: Baveno VI-criteria, i.e. liver stiffness measurement (LSM) <20 kPa and/or platelet (PLT) count >150,000/mm3) in viral compensated advanced chronic liver disease (cACLD) allow sparing 20–25% variceal screening endoscopies. Recently, less conservative strategies to further reduce unneeded endoscopies (“Expanded-Baveno VI criteria”: LSM <25 kPa and/or PLT >110,000/mm3) were proposed. Due to the limits/unavailability worldwide of LSM a “PLT >150,000/MELD 6” strategy was also suggested.