Validating and expanding the Baveno VI criteria for esophageal varices in patients with advanced liver disease: a multicenter study

Evaluating and modifying the Baveno VI criteria

Authors Adonis A. Protopapas, Theodora Mylopoulou, Vasileios P. Papadopoulos, Kiriaki Vogiatzi, Ioannis Goulis, Konstantinos Mimidis.


Introduction According to the Baveno VI workshop, patients with compensated advanced liver disease, platelet count (PLT) >150,000/μL and liver stiffness measurement (LSM) <20 kPa can avoid screening endoscopy for high-risk varices (HRVs). The purpose of this study was to validate these criteria in a multicenter Greek cohort and consider other approaches that may further decrease the number of endoscopies.

Methods We prospectively enrolled patients with advanced liver disease (defined as LSM >12 kPa) and evaluated them according to the Baveno VI criteria. Exclusion criteria were splanchnic vein thrombosis, use of β-blockers, and esophageal varices. Screening endoscopy was conducted within 6 months of liver stiffness and laboratory measurements.

Results One-hundred seven consecutive patients were enrolled in the study to undergo LSM and screening endoscopy. Of these, 13 met the Baveno VI criteria (12.1%); none of the latter had HRVs. Additional parameters were examined, among which the quotient PLT/log10LSM exhibited the largest area under the curve; concerning the latter, values ≤122,000 μL-1 x kPa-1 predicted high-risk varices with 100% sensitivity and negative predictive value (NPV), preventing 20.6% of patients from unneeded screening endoscopy (P=0.003). Moreover, values ≤92,000 μL-1 x kPa-1 exhibited 86% sensitivity and 94% NPV, preventing 44.9% of patients from unneeded screening endoscopy (P=0.001), while maintaining a tolerable percentage of overlooked patients with HRVs (6.3%).

Conclusions The Baveno VI criteria were successfully validated in our study. The quotient PLT/ log10LSM can be used to further decrease the number of screening endoscopies in patients with advanced liver disease.

Keywords Baveno VI, varices, transient elastography, screening, platelets

Ann Gastroenterol 2020; 33 (1): 87-94

Original Articles