Liver Transient Elastography Combined to Platelet Count (Baveno VI) Predict High Esophageal Varices in Black African Patient with Compensated Hepatitis B Related Cirrhosis

Abstract

Aim: To assess the predictive value of the Baveno VI criteria for the diagnosis of large esophageal varices (EV) in Black African patient with compensated hepatitis B related cirrhosis. Methods: We carried out a cross-sectional study from January 2 to July 3 (2016), in Department of Gastroenterology at University Hospitals of Cocody (CHUC) and Yopougon (CHUY). All the black African patients included were more than 15 years old and their liver elasticity score (LES) was carried out at Yopougon University Hospital. Hepatitis B related cirrhosis was defined by LES ≥ 11 kPa (FibroScan® (Echosens, France)) with positive HBs antigen (HBsAg) and anti HBc antibody. All the patients with hepatitis B related cirrhosis performed a gastroscopy at Cocody University Hospital and esophageal varices were ranked according to société française d'endoscopie digestive (SFED) classification. Data analysis was performed by SPSS model 20.0 statistics software (SPSS Inc., Chicago, IL, United States). Diagnostic performance of LES < 20 kPa and platelet count > 150,000/mmm 3 (Baveno VI criteria) for the diagnosis of large EV by gastroscopy was studied (area under the ROC curve, specificity (Sp), sensitivity (Se), positive predictive value (PPV) and negative predictive value (NPV). Results: During the study period, 720 patients achieved liver FibroScan® at CHUY. Of these, 60 respondents to our inclusion criteria were prospectively included in our study. Twelve (20%) of these 60 patients met the Baveno VI criteria. EV How to cite this paper: Stanislas, D.A., were present in 40% of cases (n = 24) with 6.7% (n = 4), 15% (n = 9) and 18.3% (n = 11) of grade 1, 2 and 3, respectively. (66.7% (n = 40) without EV or with small EV) and 33.3% (n = 20) with large EV. The Baveno VI criteria had a Se, Sp, PPV and NPV of 100%, 41.6%, 30% and 100% respectively for the diagnosis of large EV. The area under the ROC curve of a platelet count greater than 150,000/mm 3 , a liver elasticity score of less than 20 kPa and combination of both were respectively 0.763 [0.645 -0.880; P = 0.272]; 0.588 [0.436 -0.739; P = 0.01] and 0.650 [0.513 -0.787 P = 0.005]. Conclusion: The combination of liver elasticity score < 20 kPa and a blood platelet count > 150,000/mm 3 , allowed the exclusion of large esophageal varices at gastroscopy with a 100 % NPV in Black African patients with compensated hepatitis B related cirrhosis.

Baveno Criteria Safely Identify Patients With Compensated Advanced Chronic Liver Disease Who Can Avoid Variceal Screening Endoscopy: A Diagnostic Test Accuracy Meta-Analysis

“…For the same reason, only subgroups of two multicenter studies (Augustin et al, 2017; Petta et al, 2018) were eligible for inclusion (Supplementary Appendix 3). Finally, 17 journal articles and 11 conference abstracts were included (Perazzo et al, 2015; Chang et al, 2016; Maurice et al, 2016; Arriero et al, 2017; Augustin et al, 2017; Jangouk et al, 2017; Llop et al, 2017; Perez Ferrer et al, 2017; Silva et al, 2017; Sousa et al, 2017; Bae et al, 2018; Bai et al, 2018; Bellan et al, 2018; Cales et al, 2018; Colecchia et al, 2018; Kew et al, 2018; Lee et al, 2018; Levick et al, 2018; Matsui et al, 2018; McDowell et al, 2018; Ng et al, 2018; Pawar et al, 2018; Petta et al, 2018; Stanislas et al, 2018; Tadkalkar et al, 2018; Moctezuma-Velazquez et al, 2019; Thabut et al, 2019; Tosetti et al, 2019a,b). All the 28 studies provided data on missed VNT rate and SER but one conference abstract (Tosetti et al, 2019b) was used only in subgroup analysis by etiology due to overlapping study population with a full-text article in the main analysis (Tosetti et al, 2019a).…”

“…However, this meta-analysis was limited due to the available evidence because mostly conference abstracts were included and the low number of studies did not allow the restriction of study population to cACLD, nor to different etiologies. Since then, a large body of evidence has accumulated based on several high-quality diagnostic test accuracy studies (Augustin et al, 2017; Jangouk et al, 2017; Llop et al, 2017; Silva et al, 2017; Sousa et al, 2017; Bae et al, 2018; Bellan et al, 2018; Colecchia et al, 2018; Lee et al, 2018; Petta et al, 2018; Stanislas et al, 2018; Thabut et al, 2019; Tosetti et al, 2019a).…”

Noninvasive assessment oesophageal varices: impact of the Baveno VI criteria

“…Indeed, the term ‘compensated advanced chronic liver disease’ (cACLD) was coined to reflect the continuum of severe fibrosis and cirrhosis in patients with ongoing chronic liver disease [5]. Doing a gastroscopy in all patients with cACLD would result in unnecessary load to endoscopy services, and would be low yield, as the prevalence of high-risk varices in these patients is around 10–15% (Table 1) [6–29,30 ▪▪ ,31,32 ▪▪ ,33].…”

Derivation of “Egyptian varices prediction (EVP) index”: A novel noninvasive index for diagnosing esophageal varices in HCV Patients

“…Combination of Liver Stiffness (LS) and platelet count such as Baveno VI criteria [3] . Since then, some studies evaluating these recommendations have been published such as Maurice et al [16] , Adjeka Stanislas et al (2016) [17] , and Sousa et al (2017) [18] . Tosetti et al [19] proved that “Expanded Baveno VI” saved screening UGI up to 45%.…”