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

Abstract

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.

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

“…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 …”

Management of patients with pre-therapeutic advanced liver fibrosis following HCV eradication

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Application of transient elastography in nonalcoholic fatty liver disease

“…The Baveno VI criteria and its modifications are good starting points to select patients for endoscopic screening. 70 Last but not least, some studies indicate that transient elastography can be used to monitor fibrosis changes after treatment, though this should be confirmed by further studies using paired liver biopsies. 71,72…”