Transient elastography to rule out esophageal varices and portal hypertensive gastropathy in HIV-infected individuals with liver cirrhosis

Abstract

Transient elastography combined with platelet count is useful for predicting the absence of esophageal varices and portal hypertensive gastropathy and, therefore, avoid unnecessary diagnostic endoscopies in HIV-infected patients with liver cirrhosis.

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

“…With the new Expanded‐Baveno VI criteria (platelet count >110 × 10 9 cells/L + LSM <25 kPa), the number of spared endoscopies could be doubled (from 21% to 40%) with a minimal risk of missing VNT (<2%). It has to be acknowledged that similar classification rules (platelet count >100‐120 × 10 9 cells/L and LSM <25 kPa) had been reported by different authors before the Baveno VI consensus conference and in a recent abstract …”

“…This threshold was decided by experts in the Baveno VI consensus conference who agreed that 5% was a reasonable threshold for missing VNT; it was later endorsed by the American Gastroenterological Association technical review on hepatic elastography accepting a 5% false negative rate of missing high risk varices . The choice of new cut‐off values for the different parameters explored was based on published reports . The development of the continuous risk prediction model for VNT by using LSM and platelets and its corresponding nomogram was extensively reported in the Anticipate study .…”

“…In addition, a stepwise strategy using platelet count >150 × 10 9 cells/L and MELD = 6 without LSM, substantially increased the number of endoscopies avoided, maintaining a very low rate of missing VNT. Finally, changes in the platelet count and LSM cutoffs have also been suggested …”

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

“…We screened 419 references; 160 were selected for full‐text retrieval. Of these, 15 were included in the analysis …”

“…Two studies used a cut‐off of 25 kPa for liver stiffness . One study used a cut‐off of 120 000/mm 3 for platelet count . Two studies used a cut‐off of 25 kPa for liver stiffness and a cut‐off of 100 000/mm 3 for platelet count .…”