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Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced

Faiza Sadaqat Ali1, Nimrah Bader2, Bader Faiyaz Zuberi3

  • 1Faiza Sadaqat Ali, FCPS. Department of Medicine/Gastroenterology, Dow University of Health Sciences, Karachi, Pakistan.

Pakistan Journal of Medical Sciences
|January 17, 2022
PubMed

Insights

The Baveno-VI guidelines miss significant varices in compensated advanced chronic liver disease (cACLC) patients. Regional data suggests revising these screening recommendations for better accuracy in variceal detection.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Diagnostic Accuracy

Background:

  • Compensated advanced chronic liver disease (cACLD) patients require accurate screening for esophageal varices.
  • Current Baveno-VI guidelines are widely used but may not be optimal for all populations.

Purpose of the Study:

  • To validate the Baveno-VI recommendations for variceal screening in cACLD patients within a specific region.
  • To propose region-specific cutoff values for liver stiffness measurement (LSM) and platelet count to improve screening accuracy.

Main Methods:

  • A prospective cross-sectional study included 134 cACLD patients.
  • Patients were categorized based on LSM (≥20 kPa vs. <20 kPa) and platelet count (≤150 × 109 cells/L vs. >150 × 109 cells/L).
  • Gastroscopic findings (varices needing treatment [VNT], varices not needing treatment [VNNT], no varix [NV]) were analyzed using ROC curves to determine optimal cutoff values.

Main Results:

  • The Baveno-VI criteria missed 19.4% of patients with VNT.
  • A proposed LSM cutoff of 11.5 kPa demonstrated 100% sensitivity and 78% specificity for identifying VNT.
  • A platelet count cutoff of ≥97.5 × 109 cells/L showed 100% sensitivity and 83.3% specificity for VNNT.

Conclusions:

  • The Baveno-VI recommendations appear insufficient for variceal screening in cACLD patients in this region.
  • Regional adjustments to screening criteria, particularly for LSM and platelet count, are warranted to enhance the detection of significant esophageal varices.
Abstract

Keywords:
Baveno-VICirrhosisCompensated Advanced Chronic Liver DiseaseGastroscopyVarices

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