In the Journals

Baveno-VI criteria reduces endoscopies in PSC, PBC cases

Results from an evaluation of the Baveno-VI criteria showed that the criteria were applicable to patients with advanced chronic liver disease due to cholestatic liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis, according to a recently published study.

According to Carlos Moctezuma-Velazquez, MD, MSc, from the University of Alberta in Canada, and colleagues, use of the Baveno-VI criteria for patients with PBC and PSC could reduce unnecessary esophagogastroduodenoscopy by 30% to 40%.

“Since there are effective treatments for the primary prevention of variceal bleeding, until recently a screening esophagogastroduodenoscopy (EGD) was recommended in all patients with cirrhosis to detect those patients at risk of developing variceal rupture,” the researchers wrote. “However, with the progressive introduction of non-invasive methods for the diagnosis of cirrhosis, an increasing number of patients are diagnosed at an earlier, fully compensated stage of the disease, where the prevalence of varices needing treatment ... is lower, resulting in a large number of unnecessary screening endoscopies.”

The retrospective analysis included 227 patients with either PBC (n=147) or PSC (n=80) who had paired EGD and liver stiffness measurements calculated by transient elastography (LSM-TE). The standard Baveno-VI criteria used included platelet counts higher than 150 × 109/L and LSM-TE readings of less than 20 kpa.

Compared with other prediction rules for variceal bleeding that ranged in platelet count and use of either LSM-TE or MELD scores, Baveno-VI had a 0% false negative rate. Triaging patients for EGD with standard Baveno-VI criteria reduced the number of endoscopies by an average of 39%.

Use of an “expanded” Baveno-VI criteria — platelet counts higher than 110 × 109/L and LSM-TE less than 25 kPa — reduced the number of endoscopies by 58%. However, the expanded criteria increased the rate of false negatives to 6%.

“A final validation of the application of noninvasive criteria to select patients for screening EGD would come from a noninferiority randomized control trial, comparing the risk of variceal bleeding in patients undergoing universal screening EGD vs. patients selected for EGD based on noninvasive tests,” Moctezuma-Velazquez and colleagues advised. “Considering that the expected rate of [varices needing treatment] in compensated cirrhosis is [approximately] 15%, and that the risk of variceal bleeding in patients on primary prophylaxis (either with non-selective beta-blockers or endoscopic variceal ligation) is low, around 10% per year, such a trial would require a very large sample size or a long follow-up to accrue enough events.” – by Talitha Bennett

Disclosure: Moctezuma-Velazquez reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Results from an evaluation of the Baveno-VI criteria showed that the criteria were applicable to patients with advanced chronic liver disease due to cholestatic liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis, according to a recently published study.

According to Carlos Moctezuma-Velazquez, MD, MSc, from the University of Alberta in Canada, and colleagues, use of the Baveno-VI criteria for patients with PBC and PSC could reduce unnecessary esophagogastroduodenoscopy by 30% to 40%.

“Since there are effective treatments for the primary prevention of variceal bleeding, until recently a screening esophagogastroduodenoscopy (EGD) was recommended in all patients with cirrhosis to detect those patients at risk of developing variceal rupture,” the researchers wrote. “However, with the progressive introduction of non-invasive methods for the diagnosis of cirrhosis, an increasing number of patients are diagnosed at an earlier, fully compensated stage of the disease, where the prevalence of varices needing treatment ... is lower, resulting in a large number of unnecessary screening endoscopies.”

The retrospective analysis included 227 patients with either PBC (n=147) or PSC (n=80) who had paired EGD and liver stiffness measurements calculated by transient elastography (LSM-TE). The standard Baveno-VI criteria used included platelet counts higher than 150 × 109/L and LSM-TE readings of less than 20 kpa.

Compared with other prediction rules for variceal bleeding that ranged in platelet count and use of either LSM-TE or MELD scores, Baveno-VI had a 0% false negative rate. Triaging patients for EGD with standard Baveno-VI criteria reduced the number of endoscopies by an average of 39%.

Use of an “expanded” Baveno-VI criteria — platelet counts higher than 110 × 109/L and LSM-TE less than 25 kPa — reduced the number of endoscopies by 58%. However, the expanded criteria increased the rate of false negatives to 6%.

“A final validation of the application of noninvasive criteria to select patients for screening EGD would come from a noninferiority randomized control trial, comparing the risk of variceal bleeding in patients undergoing universal screening EGD vs. patients selected for EGD based on noninvasive tests,” Moctezuma-Velazquez and colleagues advised. “Considering that the expected rate of [varices needing treatment] in compensated cirrhosis is [approximately] 15%, and that the risk of variceal bleeding in patients on primary prophylaxis (either with non-selective beta-blockers or endoscopic variceal ligation) is low, around 10% per year, such a trial would require a very large sample size or a long follow-up to accrue enough events.” – by Talitha Bennett

Disclosure: Moctezuma-Velazquez reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.