Non-Invasive Prediction of High-Risk Varices in Patients with Primary Biliary Cholangitis and Primary Sclerosing Cholangitis

Moctezuma‐Velázquez, Carlos; Saffioti, Francesca; Tasayco, Stephanie; Casu, Stefania; Mason, Andrew L.; Roccarina, Davide; Vargas, Vı́ctor; Nilsson, Jan Erick; Tsochatzis, Emmanuel; Augustín, Salvador; Montaño-Loza, Aldo J.; Berzigotti, Annalisa; Thorburn, Douglas; Genescà, Joan; González-Abraldes, J.

doi:10.1038/s41395-018-0265-7

Cited by 64 publications

(44 citation statements)

References 28 publications

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“…This clear and simple definition makes this strategy easy to apply in clinical practice. Thus, our study was able to properly validate the use of the Baveno VI and expanded Baveno VI criteria in Chilean population …”

Section: Discussionmentioning

confidence: 79%

“…Some studies have replicated the validation of the Baveno VI and expanded Baveno VI criteria in European and Asian patients, observing a similar rate of the sparing of unneeded endoscopies . However, two studies have shown an elevated risk of missing VNT based on Baveno VI consensus (>5%) . Thus, the safety of these criteria must be established in different populations with different epidemiologic characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high‐risk gastro‐oesophageal varices in a Chilean cohort

Gaete

Díaz

Arenas

et al. 2020

Liver International

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Background: Baveno VI and expanded Baveno VI criteria have been recommended to circumvent the need for endoscopy screening in patients with a very low probability of varices needing treatment (VNT). Aim:To validate these criteria in a Latin American population. Methods:The ability of Baveno VI criteria (liver stiffness measurement (LSM) <20 kPa and platelet count >150 × 103/μL) and expanded Baveno VI criteria (LSM < 25kPa and platelet count >110 × 103/μL) to exclude the presence of VNT was tested in a prospectively recruited cohort of patients with Child-Pugh A liver cirrhosis and with no previous variceal haemorrhage who attended the liver clinics of three major hospitals in Chile. Results: Three hundred patients were included. The median (IQR) age was 61 [18-86] years, median MELD was 8.0 (6-17), median LSM was 17.2 (10.2-77) kPa and median platelet count was 137 (23-464) × 10 3 /μL. The main aetiology was non-alcoholic fatty liver disease (67.3%). VNT were present in 18% of patients. The Baveno VI criteria had a sensitivity of 98.1% and a specificity of 38.2%, potentially sparing 31.3% of upper endoscopies with a very low risk of missing VNT (1.1%). The expanded Baveno VI criteria had a sensitivity of 90.7% and a specificity of 61%, potentially sparing 51.3% of upper endoscopies with a risk of missing VNT of 3.6%. Both criteria were independently associated with the absence of VNT. Conclusion: We validated the Baveno VI and expanded Baveno VI criteria in Chilean population, potentially sparing 31.3% and 51.3% of endoscopies, respectively, with a very low risk of missing VNT. Fondecyt 1191183. K E Y W O R D S cirrhosis, gastrointestinal haemorrhage, gastro-oesophageal varices, liver, non-invasive, portal hypertension, transient elastography

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high‐risk gastro‐oesophageal varices in a Chilean cohort

Gaete

Díaz

Arenas

et al. 2020

Liver International

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“…Twenty-one studies were retrospective, 27,[30][31][32][35][36][37][38][39][40][41]43,44,47,[50][51][52][53]55,57,58 and hence did not use consecutive or random sampling of patients. All but 2 studies 37,59 did not report explicitly about prior knowledge of LSMs and platelet count by endoscopists.…”

Section: Quality Assessmentmentioning

confidence: 99%

Performance of Baveno VI and Expanded Baveno VI Criteria for Excluding High-Risk Varices in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Stafylidou

Paschos

Katsoula

et al. 2019

Clinical Gastroenterology and Hepatology

102

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e109. Learning Objective-Upon completion of this activity, successful learners will be able to identify the appropriate test for screening and surveillance for esophageal varices in patients with compensated advanced chronic liver disease (cACLD). BACKGROUND & AIMS:We aimed to assess the accuracy of Baveno VI criteria for identification of high-risk varices (HRVs) and varices of any size in patients with compensated advanced chronic liver disease (cACLD). METHODS:We performed a systematic search of publications through December 2018 for studies that assessed the accuracy of Baveno VI criteria for screening for varices in patients with cACLD. We used hierarchical models to synthesize evidence. We also conducted a post hoc analysis to assess the accuracy of Expanded Baveno VI criteria. We appraised the confidence in estimates using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS:We identified 30 studies (8469 participants). Pooled values of Baveno VI criteria for HRVs (26 studies) were a sensitivity of 0.97 (95% CI, 0.95-0.98) and a specificity of 0.32 (95% CI, 0.26-0.39). Pooled sensitivity of Expanded Baveno VI criteria for HRVs (12 studies) was 0.90 (95% CI, 0.85-0.93) and specificity was 0.51 (95% CI, 0.45-0.57). In 1000 patients with cACLD, with a prevalence of HRVs of 20%, Baveno VI criteria would prevent endoscopy in 262 patients, but 6 patients with HRVs would be missed. Instead, use of the Expanded Baveno VI criteria would result in 428 patients avoiding endoscopy, but 20 patients with HRVs would be missed. The credibility of our findings is moderate or low, mainly owing to the retrospective design of most studies. CONCLUSIONS:Baveno VI criteria have high diagnostic accuracy as a triage test for screening for HRVs in patients with cACLD. Expanded Baveno VI criteria could reduce the proportion of unnecessary endoscopies further, nevertheless with a higher rate of missed HRVs.

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“…Importantly, this study evaluated longitudinal trends in TE and found that increasing liver stiffness was independently associated with survival after adjustment for age, sex and bilirubin level . Furthermore, the 2015 Baveno VI guidelines recommending the use of TE and platelet count to rule out clinically significant portal hypertension have been validated in PSC . Therefore, TE is now being considered as a surrogate marker for clinical trials …”

Section: Prognosis and Risk Stratificationmentioning

confidence: 96%

Precision medicine in primary sclerosing cholangitis

Maurice

Thorburn

2019

J of Digest Diseases

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Primary sclerosing cholangitis is a rare, complex autoimmune disease in relatively young patients. There is currently no treatment for the disease, resulting in high rates of advanced liver disease leading to death or liver transplantation. However, advances have been made in our understanding of the pathophysiological mechanisms of the disease, particularly from breakthroughs in the underlying genetics. Moreover, large international collaborations have generated important clinical data that have given greater detail on the different disease phenotypes and natural history, generating new risk prediction models. As a result, drug development may be designed to target specific disease mechanisms at known points of the disease natural history. Therefore, more drugs are entering phase II and III development, giving hope that soon patient‐specific treatments may be available to treat this difficult disease.

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Non-Invasive Prediction of High-Risk Varices in Patients with Primary Biliary Cholangitis and Primary Sclerosing Cholangitis

Abstract: JGA, AB, ET and JG are members of the Baveno Cooperation.

Cited by 64 publications

References 28 publications

Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high‐risk gastro‐oesophageal varices in a Chilean cohort

Baveno VI and Expanded Baveno VI criteria successfully predicts the absence of high‐risk gastro‐oesophageal varices in a Chilean cohort

Performance of Baveno VI and Expanded Baveno VI Criteria for Excluding High-Risk Varices in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis

Precision medicine in primary sclerosing cholangitis

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