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. 2024 Jun;43(3):609-615.
doi: 10.1007/s12664-023-01458-1. Epub 2023 Oct 16.

Utility of different Baveno criteria to detect esophageal varices irrespective of their size in patients with compensated cirrhosis

Syed Ahmed  1 , Sanchit Sharma  1   2 , Samagra Agarwal  1 , Yu Jun Wong  3   4 , Martin Putera  3 , Anoop Saraya  5
Affiliations

Utility of different Baveno criteria to detect esophageal varices irrespective of their size in patients with compensated cirrhosis

Syed Ahmed et al. Indian J Gastroenterol. 2024 Jun.

Abstract

Background and aims: Esophageal varices (EVs), irrespective of size, are the most-reliable indicators of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). While non-invasive tools (NITs) accurately identify those with varices needing treatment (VNTs), their role in identifying any EVs in patients with cACLD is not known.

Methods: Patients with cACLD with reliable liver stiffness measurements (LSM), blood parameters and gastroscopy were retrospectively recruited from a multinational cohort. The performance of Baveno-VI (LSM > 20kPa and platelet count < 150,000/mm3) and expanded Baveno-VI criteria (LSM > 25kPa or platelet count < 110,000/mm3) was assessed to detect VNTs as well as any EVs. This performance was compared with the Baveno-VII possible CSPH criteria (LSM ≥ 15 kPa and platelet ≤ 150,000/mm3) to evaluate its utility in detecting any EVs.

Results: Patients with cACLD (n = 1200) of predominantly viral etiology (hepatitis B virus, 269; hepatitis C virus, 564; non-alcoholic fatty liver disease, 145; alcoholic liver disease, 130; other, 92) were included. Any EVs and VNTs were present in 514 (42.8%) and 70 (5.8%) patients, respectively. The Baveno-VI, expanded Baveno-VI and Baveno-VII criteria missed 29/514 (5.6%), 115/514 (22.4%) and 19/514 (3.7%) patients with any EVs, respectively, whereas they misclassified 517/686 (75.4%), 211/686 (30.8%) and 598/686 (87.4%) patients with no EVs as having a high risk of EVs. The Baveno-VI, expanded Baveno-VI and possible CSPH criteria missed 3/70 (4.3%), 15/70 (21.4%) and 0/70 (0%) VNTs, respectively.

Conclusion: Both original Baveno-VI and Baveno-VII criteria were highly sensitive in detecting varices in cACLD, albeit with high misclassification rates.

Keywords: Clinically significant portal hypertension; Esophageal varices; Non-invasive tool; Varices needing treatment.

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