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. 2023 Aug;58(3):346-356.
doi: 10.1111/apt.17599. Epub 2023 Jun 9.

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

Manon Allaire  1   2 , Bertille Campion  1 , Alix Demory  3 , Edouard Larrey  1 , Mathilde Wagner  4 , Marika Rudler  1 , Charles Roux  5 , Lorraine Blaise  3 , Nathalie G Carrie  2   3 , Dominique Thabut  1   6
Affiliations

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

Manon Allaire et al. Aliment Pharmacol Ther. 2023 Aug.

Abstract

Background: 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).

Aim: To evaluate their diagnostic performance in these patients.

Methods: 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.

Results: We included 185 patients; 46% were BCLC-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%.

Conclusions: Favourable Baveno VI criteria are not appropriate to rule out the presence of high-risk EV, or Baveno VII criteria to rule CSPH in/out in patients with HCC.

Keywords: Baveno criteria; acute variceal bleeding prophylaxis; hepatic venous pressure gradient; hepatocellular carcinoma; portal hypertension.

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References

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