Liver stiffness and platelet count for identifying patients with compensated liver disease at low risk of variceal bleeding

Abstract

Patients with low liver stiffness and normal platelet count have a lower risk of varices than those with either high liver stiffness or low platelet count. Varices at risk of bleeding are found in no more than 4% of patients when liver stiffness is <20 kPa and platelet count is normal.

Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease

“…The concept of cACLD, the criteria for avoiding screening endoscopy, and the criteria for selecting patients with clinically significant portal hypertension are all based on simple analytical and LSM values. (1) The original Baveno VI criteria for the triage of patients for screening endoscopy for varices (platelet count >150 3 10 9 cells/L 1 LSM <20 kPa), although well validated in subsequent studies, (8)(9)(10)(11) were also perceived as conservative; the number of spared endoscopies was relatively low, and about 40% of unneeded endoscopies would be performed using those criteria. (10) With the new Expanded-Baveno VI criteria (platelet count >110 3 10 9 cells/L 1 LSM <25 kPa), the number of spared endoscopies could be doubled (from 21% to 40%) with a minimal risk of missing VNT (<2%).…”

“…Based on preliminary information from studies suggesting that liver stiffness measurement (LSM) by transient elastography, in combination with other noninvasive parameters, was useful for "ruling out" patients with cACLD needing screening endoscopy, (4)(5)(6)(7) the Baveno VI recommendations indicated that patients with cACLD, an LSM <20 kPa, and a platelet count >150 3 10 9 cells/L have a very low risk of VNT and consequently can safely avoid the screening endoscopy. (1) Following that recommendation, several studies have now confirmed the validity of this risk classification rule, (8)(9)(10)(11) which allows sparing between 10% to 30% of screening endoscopies with a very low risk of missing VNT. However, due to the low prevalence of VNT in these patients with cACLD (<10%), up to 40% of unneeded endoscopies would still be performed.…”

Systematic review with meta‐analysis: automated low‐flow ascites pump therapy for refractory ascites

“…Meta‐analysis is a quantitative technique that enables pooling data from trials in order to decrease random errors. It also allows for assessment of the magnitude of impact of a particular factor . In this study, we performed a meta‐analysis of trials evaluating automated low‐flow ascites pump therapy in patients with cirrhosis and refractory ascites.…”

Non-invasive diagnosis of esophageal varices after Baveno VI

“…Of note, there was no significant heterogeneity among the studies. However, the definition of VNT was different among the studies and although most were conducted in compensated patients, four of them also included decompensated patients in the analysis (46).…”