Screening For Varices Research Articles

Evaluation and management of hepatic dysfunction, portal hypertension and portal/splanchnic vein thrombosis in patients with myelofibrosis undergoing allogeneic haematopoietic cell transplantation: A practice based survey on behalf of the Chronic Malignancies Working Party of the EBMT

Heterogeneous approaches exist in regard to the management of disease-related co-morbidities in potential allogeneic haematopoietic cell transplantation (allo-HCT) candidates with myelofibrosis (MF). The EBMT Chronic Malignancies Working Party launched an electronic survey to evaluate how MF-specific comorbidities are approached and whether they ultimately affect the decision to transplant. A total of 41/63 (65%) Centers, all of whom were experienced in the management of MF allo-HCT, responded. Responses were aggregated and reported in a comparative fashion. Screening for portal hypertension (PH) was routinely performed in 54% centers, never in 12% and guided by clinical manifestations in the remaining. Involvement of hepatologists/gastroenterologists was always/very often considered in patients with signs of PH prior to transplant. Centers reported that radiological evidence of PH did not routinely represent a formal contraindication for allo-HCT in most cases (78%). Of note, most centers (61%) did not perform routine screening for gastroesophageal varices; this was systematically considered or guided by clinical manifestations in only 7% and 32% centers, respectively. Presence of gastroesophageal varices was always (15%) or occasionally (19%) considered a formal contraindication to allo-HCT. A prior history of portal vein thrombosis never (78%) or occasionally (15%) represented a formal contraindication. Three Centers would not proceed to transplant in such cases. Less importance was assigned to non-portal splanchnic vein thrombosis (SVT), with all but one centre proceeding to transplant regardless of prior SVT. This survey highlights a considerable heterogeneity across responding centers in approaching MF-related comorbidities prior to transplant, suggesting that harmonisation guidelines are needed to address these issues in this patient population.

Performance of Baveno VII criteria for the screening of varices needing treatment in patients with biliary atresia.

Biliary atresia (BA) is the leading cause of liver cirrhosis and chronic liver insufficiency in children in the world. Gastroesophageal varices bleeding is an ominous complication of cirrhosis in BA patients and is associated with high morbidity and mortality. In this study, we aimed to investigate the utility of noninvasive Baveno VIand Baveno VII criteria for the screening of varicesneed treatment (VNT) and the need for liver transplantation in BA patients. This study enrolled 48 BA patients (23 females and 25 males) who underwent an esophagogastroduodenoscopy (EGD) and transient elastography at a mean age of 11.18 ± 1.48 years; the clinical data were surveyed in a retrospective design. The sensitivity and negative predictive valueof Baveno VI and Baveno VII criteria for the prediction of VNT in BA patients are both 100% and 100%, respectively. The VNT missing rate of Baveno VI and Baveno VII criteria are both 0% in our cohort. The Baveno VI, expanded Baveno VI, and Baveno VII criteria are also predictive of the need for liver transplantation in our cohort (OR = 10.33, 4.24, and 21.33; p = 0.009, 0.03, and 0.007, respectively). The Baveno VI and Baveno VII criteria are useful for the screening of VNT and minimize non-necessary invasive EGD in BA patients with low VNT missing rates. The Baveno VI, expanded Baveno VI, and Baveno VII criteria are associated with the need for liver transplantation.

Higher frequency of gastric neoplasia in advanced chronic liver disease patients: Impact of screening endoscopy in an intermediate-high risk country

BackgroundThe Baveno VII guidelines were proposed to identify which patients could safely avoid screening esophagogastroduodenoscopy (EGD) for gastroesophageal varices. We aimed to evaluate the frequency of gastric neoplasia in compensated advanced chronic liver disease (cACLD) patients who underwent EGD for screening of gastroesophageal varices (GOEV) compared to a healthy population. MethodsRetrospective study that enrolled all cACLD patients who underwent EGD for GOEV screening (January 2008-June 2018) in a tertiary reference center. cACLD patients were compared with asymptomatic healthy individuals who underwent EGD in a private hospital setting (April 2017-March 2018). ResultsWe evaluated 1845 patients (481 cACLD patients, 1364 healthy individuals). A significantly higher frequency of gastric neoplasia was observed in patients with cACLD compared to healthy individuals (4.0% vs. 1.0 %; p < 0.001). Rare histopathological subtypes (WHO Classification) accounted for 28.7 % of gastric carcinoma cases in the cACLD cohort. Seven cases of gastric neoplasia (36.8 % of gastric neoplasia cases in the cACLD patients) were diagnosed in patients who, according to the Baveno VII criteria, would have not been submitted to EGD. ConclusionWe found an increased frequency of gastric neoplasia in patients with cACLD in comparison with healthy individuals. In countries with intermediate-high risk for GC, continuing to perform EGD could be beneficial.

Screening for exclusion of high-risk bleeding features of esophageal varices in cirrhosis through CT and MRI

Background & aimEsophageal varices (EV) screening guidelines have evolved with improved risk stratification to avoid unnecessary esophagogastroduodenoscopy (EGD) in individuals with low bleeding risks. However, uncertainties persist in the recommendations for certain patient groups, particularly those with hepatocellular carcinoma (HCC) and/or receiving non-selective beta-blockers (NSBB) without prior endoscopy. This study assessed the efficacy of imaging in ruling out EVs and their high-risk features associated with bleeding in patients with cirrhosis and with HCC. We also evaluated the impact of NSBB on the detection of these characteristics. MethodsA total of 119 patients undergoing EGD with CT and/or MRI within 90 days of the procedure were included. 87 patients had HCC. A new imaging grading system was developed utilizing the size of EVs and the extent of their protrusion into the esophagus lumen. The negative predictive value (NPV) of EVimaging(−) versus EVimaging (+) (grades 1–3) in ruling out the presence of EV and/or high-risk features by EGD was calculated. The predictive performance of imaging was determined by logistic regression. ResultsThe NPV of imaging for detecting EV and high-risk features was 81 % and 92 %, respectively. Among HCC patients, the NPV for EV and high-risk features was 80 % and 64 %, respectively. Being on NSBB didn't statistically impact the imaging detection of EV. Imaging was a better predictor of high-risk EGD findings than Child-Turcotte-Pugh scores. ConclusionsOur results suggest that imaging can effectively rule out the presence of EV and high-risk features during EGD, even in patients with HCC and/or receiving NSBB.

Magnetic resonance elastography (MRE) outperforms acoustic force radiation impulse (ARFI) in predicting oesophageal varices in obese NAFLD cirrhosis.

Liver stiffness measurement (LSM) by transient elastography has been shown to underperform in high-risk varices (HRVs) prediction in obese non-alcoholic fatty liver disease (NAFLD) compensated cirrhosis (CC). LSM by magnetic resonance elastography (MRE) and acoustic force radiation impulse (ARFI) has been shown to be useful in prediction of oesophageal varices (EVs), but has limited evidence in obese NAFLD-CC. Obese patients with NAFLD-CC who underwent MRE and ARFI for LSM and endoscopy for screening of varices were enrolled. Performance of MRE and ARFI for predicting EVs or HRVs was evaluated using area under receiver operating characteristics (AUROC) curves and regression analyses were performed for predictor variables. One hundred eight patients [mean age 54.7 ± 9.6years, median BMI, 28.5 (26.4-30.0) kg/m2. 72.2% diabetics, 45.4% hypertensive] were enrolled. Fifty-two (48.1%) had no varices, while 29 (26.8%) and 27 (25%) had low-risk varices (LRVs) and HRVs, respectively. MRE-LSM was higher in patients with LRVs (p = 0.01) or HRVs (p = 0.001) against those without varices. ARFI-LSM did not differ significantly between those without and with LRVs or HRVs (p > 0.05 for all). There was a low correlation between ARFI-LSM and MRE-LSM in the overall cohort (r = 0.19). Only platelet count (PC) [0.98 (0.97-0.99)] and MRE-LSM [1.8 (1.26-2.79)] were predictors of HRVs. At a cut-off of 4.75, MRE showed a sensitivity of 96.3%. Model combining MRE-LSM with PC had a diagnostic AUROC of 0.77 and 0.76 for EVs and HRVs. In obese NAFLD-CC, MRE-LSM is significantly higher in patients with varices. MRE combined with PC predicts EVs and HRVs with better accuracy than ARFI.

Diagnostic accuracy of magnetically guided capsule endoscopy with a detachable string for detecting oesophagogastric varices in adults with cirrhosis: prospective multicentre study

ObjectiveTo evaluate the diagnostic accuracy and safety of using magnetically guided capsule endoscopy with a detachable string (ds-MCE) for detecting and grading oesophagogastric varices in adults with cirrhosis.DesignProspective multicentre diagnostic...

Biopsy forceps are useful for measuring esophageal varices in vitro.

To avoid acute variceal bleeding in cirrhosis, current guidelines recommend screening for high-risk esophageal varices (EVs) by determining variceal size and identifying red wale markings. However, visual measurements of EV during routine endoscopy are often inaccurate. To determine whether biopsy forceps (BF) could be used as a reference to improve the accuracy of binary classification of variceal size. An in vitro self-made EV model with sizes ranging from 2 to 12 mm in diameter was constructed. An online image-based survey comprising 11 endoscopic images of simulated EV without BF and 11 endoscopic images of EV with BF was assembled and sent to 84 endoscopists. The endoscopists were blinded to the actual EV size and evaluated the 22 images in random order. The respondents included 48 academic and four private endoscopists. The accuracy of EV size estimation was low in both the visual (13.81%) and BF-based (20.28%) groups. The use of open forceps improved the ability of the endoscopists to correctly classify the varices by size (small ≤ 5 mm, large > 5 mm) from 71.85% to 82.17% (P < 0.001). BF may improve the accuracy of EV size assessment, and its use in clinical practice should be investigated.

Utility of P²MS Index in Predicting Esophageal Varices in Patients with Hepatitis C Associated Chronic Liver Disease in Pakistani Population

Background: Screening for esophageal varices (EVs) in patients with chronic liver disease is critical for identifying those needing primary prophylaxis against variceal bleeding. The gold standard for EV screening is endoscopy, an invasive and costly procedure often avoided by patients. This necessitates the need for non-invasive predictive tools for the presence of EVs and high-risk varices (HRVs). The P²MS index, a relatively new model, has shown promise in this regard. Objective: This study aimed to evaluate the effectiveness of the P²MS index, alongside APRI and FIB-4 scores, in predicting the presence of EVs and HRVs in patients with hepatitis C-related chronic liver disease. Methods: Conducted at the Sindh Institute of Urology and Transplantation's Hepato-Gastroenterology department, this cross-sectional study involved 375 participants aged 18-50 years, recently diagnosed with liver cirrhosis due to hepatitis C. Excluding those with varied medical backgrounds, the study used non-probability consecutive sampling. Diagnostic procedures included esophagogastroduodenoscopy (EGD) and complete blood count. P²MS index, APRI, and FIB-4 scores were calculated for each participant. Data analysis was performed using SPSS version 25.0, focusing on the Area Under the Receiver Operating Curve (AUROC) to assess diagnostic accuracy. Results: In our population, the P²MS index at a cutoff of &lt;10.7 showed a specificity of 93.22% and sensitivity of 87.88% for predicting the presence of EVs, with a PPV and diagnostic accuracy exceeding 90%. For HRVs, a cutoff of &lt;5.4 demonstrated an excellent NPV, alongside good sensitivity, specificity, and diagnostic accuracy. Compared to APRI and FIB-4, the P²MS index had the highest AUROC for predicting the presence of EVs (0.92, 95% CI 0.89-0.95, p&lt;0.001). For HRVs, it was comparable to APRI (AUROC=0.88, 95% CI 0.85-0.92, p&lt;0.01) and superior to FIB-4. Conclusion: The P²MS index is an effective non-invasive tool for screening EVs in patients with hepatitis C-related chronic liver disease, demonstrating high accuracy for predicting the presence of EVs. However, its efficacy in predicting HRVs is comparable to other non-invasive indices and warrants further validation.

Spleen-dedicated stiffness measurement performed well to rule out high-risk varices in HBV-related hepatocellular carcinoma: Screening for high-risk varices in HCC.

Esophagogastroduodenoscopy (EGD) is required to screen for high-risk varices (HRV) in patients with hepatocellular carcinoma (HCC), especially since overall survival rates have dramatically improved with new systemic therapies. To assess the Baveno VI and Baveno VII algorithms' ability to rule out HRV in hepatitis B virus (HBV)-related HCC METHODS: We prospectively enrolled consecutive patients with HBV related, compensated cirrhosis and newly diagnosed HCC who underwent liver stiffness measurement, spleen stiffness measurement (SSM) using a 100-Hz shear wave frequency, and EGD. From September 2021 to August 2023, we enrolled 219 patients with HCC, with 107 (48.9%) Barcelona Clinic Liver Cancer (BCLC) A, 28 (12.8%) BCLC B and 84 (38.3%) BCLC C, respectively. HRV prevalence was 28.8% (63/219). Baveno VI criteria safely (HRV missing rate, 3.2%) avoided 27.4% unnecessary EGDs, while the Baveno VII algorithm avoided 49.3% with HRV missing rate at 7.9% (5/63). The SSM ≤40 kPa avoided 47.5% of EGDs safely (HRV missing rate, 4.8%), significantly better than the Baveno VI criteria (p < 0.001) and comparable to the Baveno VII algorithm (p = 0.390). The SSM ≤40 kPa safely avoided EGDs in patient subgroups within Milan criteria, with portal vein tumour thrombosis or BCLC B/C or candidates for systemic therapy. We validated that the SSM ≤40 kPa using a 100-Hz probe could safely eliminate more unnecessary EGDs than the Baveno VI criteria in patients with HBV-related HCC. However, the efficacy of the Baveno VII algorithm in patients with HCC requires further investigation.

Endohepatology in clinical practice: EUS-guided portal pressure measurement combined with EUS-guided liver biopsy and variceal screening and treatment in outpatients.

EUS-guided portal pressure gradient (PPG) is a novel technique that permits a true, direct measure of portal vein pressure and hepatic vein pressure. This article details our experience and lessons learned from 20 consecutive outpatient EUS-PPG procedures performed at a single center, along with simultaneous EUS-guided liver biopsy, variceal screening, and variceal banding. Data on the first 20 patients who underwent EUS-PPG at a single center were retrospectively viewed and analyzed. The effects of various liver diseases or other patient-related factors on the clinical and technical success of EUS-PPG measurements, as well as EUS-guided liver biopsy (EUS-LB), were evaluated. During the procedure, if esophageal varices were encountered, they were assessed, and if felt to be clinically indicated, endoscopic variceal ligation was performed. The 20 patients included 10 male and 10 female patients. All procedures were technically successful. In all patients, the portal vein and hepatic veins could be easily identified. One adverse event of bleeding occurred during the EUS-PPG measuring procedure. All 20 EUS-LBs were technically successful and yielded adequate samples for histological evaluations, with an average of 25 complete portal tracts per sample. Among patients with esophageal varices, 40% of patients underwent banding. The mean EUS-PPG among 5 patients with esophageal varices was 11.6 mm Hg, compared with 3.2 mm Hg among 15 patients without esophageal varices. This study demonstrates that EUS-PPG is a novel, safe, reproducible, and effective technique. Also, the fact that EUS-PPG, EUS-LB, variceal screening, and variceal banding could be performed in 1 session and on an outpatient basis speaks to the growing relevance and impact of the nascent field of endohepatology.

Accuracy of non-invasive diagnosis of esophageal varices among cirrhotic patients in a low-income setting

Cirrhosis is a chronic liver disease that is frequently complicated by increased portal venous pressure and the formation of EV. The most common clinical manifestation of portal hypertension is esophageal varices, and ruptured varices are the most fatal complication of portal hypertension. The diagnosis and follow-up of esophageal varices is done by Esophagogastroduodenoscopy, but in most developing countries, the follow-up of cirrhotic patients by gastrointestinal endoscopy remains a challenge. ObjectiveAssessment of diagnostic accuracy of noninvasive tests as predictors of esophageal varices among cirrhotic patients at University of Gondar comprehensive Hospital. MethodInstitution based cross-sectional study was conducted among cirrhotic patients from March 2022–October 2022. All study participants underwent screening for Esophageal Varices, Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio. Data were analyzed using SPSS version 26. ROC curves were plotted for Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio with specific cutoffs determined. Diagnostic performance was assessed using ROC curve. The diagnostic thresholds were specified with their sensitivity, specificity, positive predictive value, negative predictive value positive and negative likelihood ratios. ResultA total of 206 patients were included. The mean age was 41.84 year and SD of (41.84 ± 12.398). About 79.4 % percent were males. Endoscopy confirmed esophageal varices were present in 176(85.4 %) cases. Sixty-seven percent of cases had decompensated cirrhosis (Child-Pugh class B&C). The platelet count to spleen diameter ratio less than 818 had a PPV of 94.7 % (AUROC = 0.835), while spleen diameter greater than 145 mm had 93.7 % PPV (AUROC = 0.783). At a platelet count cutoff <121,000/mm3, the PPV was 95.1 % (AUROC = 0.818). ConclusionIn this study, platelet count, spleen diameter, and PC/SD all performed well for EV diagnostics, with PC/SD outperforming the others. This finding supports the use of these noninvasive indicators for the diagnosis and implementation of prophylactic treatment foe esophageal varices in health institutions where gastrointestinal endoscopy is unavailable.

Screening of Esophageal Varices in Patients With Fontan Palliation

Screening of Esophageal Varices in Patients With Fontan Palliation

Screening for esophageal varices from Baveno V to Baveno VII

Screening for esophageal varices from Baveno V to Baveno VII

Spleen stiffness: a new tool to predict high-risk varices in cirrhotic patients.

Cirrhosis is one of the major causes of morbidity and mortality worldwide. Portal hypertension is the major contributor of cirrhosis-related complications and is defined as a hepatic venous pressure gradient (HVPG)>5mmHg. Measurement of HVPG is an invasive, difficult, and costly procedure. Therefore, it is only performed in specialized centers. Liver stiffness measured with transient elastography is one of the most studied noninvasive markers of portal hypertension, and spleen elastography has recently emerged as an important adjuvant tool. The development of a new probe (100Hz) that more reliably reflect the grade of portal hypertension evaluated by spleen stiffness measurement has improved the accuracy of this technique. The aim of this work was to evaluate the accuracy of spleen stiffness with the new dedicated probe to predict the presence of high-risk varices, as well as to determine the ideal cutoff to predict it. Prospective study of cirrhotic patients admitted to upper endoscopy that were also submitted to liver and spleen elastography with the 100-Hz probe by the same blinded operator in a tertiary center. We included 209 cirrhotic patients, with mean age of 61.9years (±9.9), 77.0% male. The most common etiology was alcoholic liver disease (72.7%). The median value of liver elastography was 25.3 [4.5-75] kPa, and the median value of spleen elastography was 42.4 [7.6-100] kPa. At the cutoff of 53.25kPa, we obtained sensitivity of 100% and specificity of 72.6% to predict high-risk varices, and, according to this cutoff, 133/175 of esophagogastroduodenoscopy could have been spared (76.0%), while according to Baveno guidelines, only 51/175 would have been spared (29.1%). In the era of noninvasive exams, spleen elastography with the 100-Hz probe emerges as an excellent tool for prediction of presence of high-risk varices. At the cutoff of 53.25kPa, spleen elastography avoids upper endoscopy for screening for high-risk varices, promising to be become part of the hepatologists' daily routine.

Amyloid A in Serum and Ascetic Fluid as a Marker of Spontaneous Bacterial Peritonitis

Abstract Background Esophageal varices (EV) are a major complication of cirrhosis secondary to the development of clinically significant portal hypertension EV can lead to life-threatening bleeding, further decompensation and death among patients with cirrhosis. Aim of the Work The aim of this study is to assess the role of the clinical usefulness of the Amyloid A (serum and ascetic fluid) in patients with ascites (liver cirrhosis) and as a diagnostic marker for Spontaneous Bacterial Peritonitis. Patients and Methods This prospective study was conducted on 240 cirrhotic patients selected randomly presented for screening for esophageal varices at Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital Hospitals and at Kafr El- Shiekh Liver Research center Results The cause of cirrhosis was HCV in 205 patients (85.42%), HBV in 14 patients (5.83%), BHF in 47 patients (19.58%) with, AIH in 6 patients (2.5%) and other diseases in 21 patients (8.75%). the prevalence of oesophageal varices and its staging were 55 patients (22.9%) had no oesophageal varices, 44 patients (18.3%) had esophageal varices grade I-II (Small EVs) and 141 patients (58.8%) had oesophageal varices grade III-IV (Large EVs). According to Child-Pugh (CP) Score, 129 (53.75%) patients were Child A, 72 (30%) patients were Child B and 39 (22.9%) patients were Child C. ALBI ranged from -3.2 - (-0.42) with mean value −1.94 ± - 0.74. 67 (27.9%) patients were ALBI 1, 100 (41.7%) patients were ALBI 2 and 73 (30.4%) patients were ALBI 3. 50 (20.83%) patients were ALBI-PLT 2, 30 (12.5%) patients were ALBI-PLT 3, 88 (36.67%) patients were ALBI-PLT 4, 72 (30.0%) patients were ALBI-PLT 5. There was a significant difference among cirrhotic patients regarding EVs as regard to hemoglobin, platelets, APRI, albumin, total bilirubin, ALBI, ALBI-PLT, INR, Child-Pugh (CP) score, platelet count/spleen diameter ratio, spleen size and ascites (P &amp;lt; 0.001). Regarding the presence of EV, ALBI, ALBI-PLT, Child-Pugh (CP) Score and platelet count/spleen diameter ratio, are good predictors for the presence of oesophageal varices. ALBI at cut-off &amp;gt;-2.6 can predict oesophageal varices with sensitivity 83.77, specificity 53.06, PPV 87.4, NPV 45.6, AUC 0.711 and P-value &amp;lt;0.001, ALBI- PLT at cut-off &amp;gt;2 can predict oesophageal varices with sensitivity 96.48, specificity 87.76, PPV 96.9, NPV 97.7, AUC 0.982 and P-value &amp;lt;0.001. Regarding differentiation between Small EVs and large EVs, This study showed that ALBI, ALBI-PLT, Child-Pugh (CP) Scores, platelet count/spleen diameter ratio, spleen size and APRI could be used in prediction of the size of EVs, ALBI at cut-off &amp;gt;-2.03 can predict the size with sensitivity 95.28, specificity 93.75, PPV 96.8, NPV 90.9, AUC 0.971 and Pvalue &amp;lt;0.001. Conclusion Combined ALBI grade and platelet count (ALBI-PLT score), albumin-bilirubin ratio (ALBI), could be used as a serum non-invasive marker of the presence of oesophageal varices which may help in reducing unnecessary endoscopies and a good selection of patients who need an endoscopy to decrease intervention and burden on endoscopy units.

Baveno VI and VII criteria are not suitable for screening for large varices or clinically significant portal hypertension in patients with hepatocellular carcinoma.

Baveno VI and VII criteria are used in patients with cirrhosis to rule out large size oesophageal varices (EV) and rule in/out clinically significant portal hypertension (CSPH). To evaluate their diagnostic performance in these patients. We retrospectively included all patients with Child-Pugh A cirrhosis and HCC who had endoscopy, liver stiffness measurement (LSM) and platelet count within 6 months. They were classified according to the BCLC stage. Favourable Baveno VI criteria were defined by LSM < 20 kPa and platelets > 150 G/L (to rule out large EV), favourable Baveno VII criteria if LSM ≤ 15 kPa and platelets ≥ 150 G/L (to rule out CSPH, which was defined by a HVPG ≥ 10 mm Hg. We included 185 patients; 46% wereBCLC-0/A, 28% BCLC-B and 26% BCLC-C. EV were present in 44% (23% large), and HVPG ≥ 10 mm Hg in 42% (mean 8 mm Hg). In patients with favourable Baveno VI criteria, 8% of the whole cohort (Se 93%, NPV 92%), 11% of BCLC-0-A (Se 89%, NPV 89%) and 10.0% of BCLC-C patients (Se 91%, NPV 90%) had large EV. Among patients with HVPG < 10 mm Hg, 6% had large EV and 17% small. CSPH was present in 23% of patients with favourable Baveno VII criteria among the whole cohort, and in 25% of those with BCLC-0/A. The specificity of LSM ≥ 25 kPa to rule in CSPH was 48%. Favourable Baveno VI criteria are not appropriate to rule out the presence of high-risk EV, or Baveno VII criteria to rule CSPHin/out in patients with HCC.

CME: Outpatient Management of Patients with Liver Cirrhosis

CME: Outpatient Management of Patients with Liver Cirrhosis Abstract: Many causes of cirrhosis are modifiable. Therefore, etiologic clarification is mandatory. After diagnosis, the underlying disease must be treated and patients advised as to alcohol abstinence, smoking cessation, healthy diet, vaccinations and physical exercise. Gastroscopic screening for oesophageal varices is recommended. Patients with cirrhosis should undergo surveillance for hepatocellular carcinoma (biannual sonography and alpha-fetoprotein assessment). Following a first complication (e.g., variceal haemorrhage, ascites, encephalopathy) or deterioration of liver function, listing for liver transplantation should be evaluated. Control intervals should be individualized according to disease severity and previous decompensations. Many complications (e.g., bleeding, spontaneous bacterial peritonitis, acute renal failure due to NSAIDs or diuretics) have insidious onsets but may rapidly lead to multiple organ failure. Rapid diagnostics are recommended if patients show clinical, mental or lab deterioration.

FRI-274 - Baveno VI and VII criteria are not suitable for screening of large size esophageal varices and clinically significant portal hypertension in patients with HCC

FRI-274 - Baveno VI and VII criteria are not suitable for screening of large size esophageal varices and clinically significant portal hypertension in patients with HCC

SAT-557 - MELD 3.0 score in prediction of varices and comparison with its previous versions in patients undergoing esophago-gastro-duodenoscopy for variceal screening or band ligation

SAT-557 - MELD 3.0 score in prediction of varices and comparison with its previous versions in patients undergoing esophago-gastro-duodenoscopy for variceal screening or band ligation

Utility of EVendo Score as a Screening Tool for the Detection of High Risk Esophageal Varices in Pakistani Population

Introduction: Endoscopy for the screening of esophageal varices (EVs) is costly and cannot be performed in remote areas with limited resources. Recently, certain non-invasive cost effective models have been proposed for the prediction of EVs but have failed recommendation on a larger scale. EVendo score is a recently developed bedside score for the detection of EVs. Therefore, our aim was to determine the utility of EVendo score as a screening tool for the detection of high risk esophageal varices in Pakistani population.&#x0D; Methods: It was a cross sectional study which was conducted in the department of Hepatogastroenterology from January 2021-June 2022.All the patients of either gender aged greater than 18 years with newly diagnosed cirrhosis were included in the study while those patients with prior history of esophageal varices and variceal bleeding as well as those with acute liver failure, renal impairment, non-cirrhotic portal hypertension and those on anticoagulants were excluded from the study. Area under the receiver operating curve (AUROC) was obtained for EVendo score, Aspartate Transaminase to platelet ratio(APRI) and Platelet count to Splenic Diameter and diagnostic accuracy was obtained for these scores in predicting EVs and also in identifying HRVs.&#x0D; Results: A total of 272 patients were enrolled in the study. Among them, 167(61.4%) were males. Most common cause of chronic liver disease was viral hepatitis.On screening endoscopy, EVs were noted in 118(43.4%) patients while high risk EVs (HRV) were noted in 47(17.3%) patients respectively. AUROC was obtained for EVendo score, APRI and Platelet count to Splenic Diameter in predicting EVs and also for identifying HRVs and it was 0.93 (p-value &lt;0.001), 0.821(&lt;0.001) and 0.842(p&lt;0.001) respectively for the prediction of EVs with diagnostic accuracy of 86.76% and 0.852 (p-value &lt;0.001), 0.835(&lt;0.001) and 0.814(p&lt;0.001) respectively for identifying HRVs with a diagnostic accuracy of 84.19%.&#x0D; Conclusion: The performance of EVendo score was reliable and better than the other non-invasive scores in predicting EVs in our population with an excellent sensitivity and diagnostic accuracy in predicting the EVs and also in identifying HRVs. However, studies comprising larger sample sizes are required in this regard.