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Updated: Mar 8, 2026
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
Validating, deconstructing and refining Baveno criteria for ruling out high-risk varices in patients with compensated
Parastoo Jangouk1,2, Laura Turco1,2,3, Ana De Oliveira1,2,4
1Section of Digestive Diseases, VA-Connecticut Healthcare System, West Haven, CT, USA.
Insights
Baveno VI criteria effectively rule out high-risk varices in cirrhosis patients, avoiding unnecessary endoscopies. An alternative strategy using platelet count and MELD score also proved accurate, especially in low-prevalence settings.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Diagnostics
Background:
- Guidelines recommend variceal screening for cirrhosis patients to prevent bleeding.
- Non-invasive methods are sought to avoid unnecessary endoscopies for high-risk varices.
- Baveno VI criteria (liver stiffness <20 kPa and platelet count >150,000/mm³ ) identify patients eligible for endoscopy avoidance.
Purpose of the Study:
- Validate Baveno VI criteria in diverse cohorts.
- Assess alternative non-invasive parameters for ruling out high-risk varices.
- Determine if liver stiffness is essential for accurate risk assessment.
Main Methods:
- Retrospective analysis of two cohorts (US and Italian) with liver stiffness and endoscopy data.
- Patients with liver stiffness >10 kPa were included if measurements were within one year of endoscopy.
- Evaluation of Baveno VI criteria and alternative strategies including platelet count and MELD score.
Main Results:
- Baveno VI criteria accurately identified patients without high-risk varices, allowing for avoided endoscopies (26% US, 16% Italy).
- Sensitivity and negative predictive value for Baveno VI criteria were 100%.
- A stepwise strategy using platelet count >150,000 and MELD score=6 increased avoided endoscopies to 54% (US) while maintaining 100% sensitivity and NPV.
Conclusions:
- Baveno VI criteria are validated for ruling out high-risk varices, especially in low-prevalence populations.
- An alternative strategy excluding liver stiffness demonstrates high accuracy.
- These findings support non-invasive approaches to manage cirrhosis patients and reduce endoscopic procedures.
Background:
Guidelines recommend variceal screening in patients with cirrhosis to identify varices at high risk of bleeding requiring primary prophylaxis. Non-invasive criteria to rule out high-risk varices will avoid unnecessary endoscopies. Recent Baveno VI criteria define patients with compensated cirrhosis in whom endoscopy can be avoided as those with a liver stiffness by transient elastography <20 kPa and a platelet count >150 000/mm3. AIMS: To validate Baveno criteria in two cohorts with a different prevalence of high-risk varices and to determine whether alternate parameters not including liver stiffness would be equal/more accurate in ruling out high-risk varices.
Methods:
Retrospective study evaluating patients with liver stiffness >10 kPa who had liver stiffness and endoscopy within 1 year of each other.
Results:
This study included 161 patients from the US cohort (14 [9%] with high-risk varices) and 101 patients from an Italian cohort (17 [17%] with high-risk varices). Of patients meeting Baveno criteria (41 in the US, 16 in Italy), none had high-risk varices and therefore 26% (US) and 16% (Italy) endoscopies could have been avoided. Sensitivity and negative predictive value were 100%. A stepwise strategy using platelet count >150 000 and MELD=6, increased the number of endoscopies avoided to 54% (US) while maintaining a sensitivity and negative predictive value of 100%. Excellent sensitivity and negative predictive value were validated in the Italian cohort and in another cohort of patients with a clinical diagnosis of cirrhosis.
Conclusions:
This study validates Baveno VI criteria, particularly in sites with a low prevalence of high-risk varices and describes a new accurate strategy that does not include liver stiffness.
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