Combining Spleen Diameter and the Baveno VI Criteria Assessed by 2-Dimensional Shear Wave Elastography to Rule Out
Zhilin Zhang1, Huihui Zhou2, Kunlong Duan2
1Department of Ultrasound, PLA General Hospital of Southern Theatre Command, Guangzhou.
Insights
The Baveno VI criteria, using 2D-SWE, safely identify compensated advanced chronic liver disease patients who can avoid screening endoscopy. Combining these criteria with spleen diameter further increases the number of spared procedures while maintaining safety.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Imaging
Background:
- Compensated advanced chronic liver disease (cACLD) patients often undergo screening esophagogastroduodenoscopy (EGD) to detect high-risk varices (HRVs).
- The Baveno VI criteria, traditionally assessed by transient elastography, help identify patients who can safely forgo EGD.
- Recent proposals suggest using 2-dimensional shear wave elastography (2D-SWE) for Baveno VI criteria assessment.
Purpose of the Study:
- To validate the Baveno VI criteria using 2D-SWE for ruling out HRVs in cACLD patients.
- To assess if combining spleen diameter (SPD) with the Baveno VI criteria can increase the rate of spared EGD screenings.
- To identify independent predictors of HRVs in cACLD patients.
Main Methods:
- A study involving 173 cACLD patients with successful liver stiffness (LS) measurements and EGD examinations.
- Analysis of risk factors for HRVs, including platelet count, LS, spleen stiffness, and SPD.
- Comparison of the diagnostic performance of different models for ruling out HRVs.
Main Results:
- Platelet count, LS, and SPD were identified as independent predictors of HRVs.
- The Baveno VI criteria assessed by 2D-SWE spared 25.4% of EGD screenings, missing 2.4% of HRV patients.
- Combining SPD ≤11.1 cm with the Baveno VI criteria increased spared EGD screenings to 45.1% (P < 0.001) while missing 4.9% of HRV patients.
Conclusions:
- The Baveno VI criteria assessed by 2D-SWE can be safely applied to rule out HRVs in cACLD patients.
- The combined Baveno VI/SPD model significantly increases the rate of spared EGD screenings compared to the Baveno VI criteria alone.
- This combined approach offers a safe and more efficient strategy for managing screening EGD in cACLD patients.
Abstract:
Patients with compensated advanced chronic liver disease (cACLD) can safely spared screening esophagogastroduodenoscopy (EGD) when they meet the Baveno VI criteria as assessed by transient elastography. Recently, the cutoff values of the Baveno VI criteria assessed by 2-dimensional shear wave elastography (2D-SWE) were proposed. We aimed to validate it to rule out high-risk varices (HRVs) in cACLD patients; combine spleen diameter (SPD) with the Baveno VI criteria and assess whether it can spare more screening EGD. A total of 173 cACLD patients with successful liver stiffness (LS) measurements and EGD examinations were included. We analyzed the risk factors that predicted HRVs and compared the performances of different models for ruling out HRVs. The platelet count, LS, and SPD were independent predictors of HRVs. The AUCs of platelet count, LS, spleen stiffness and SPD for diagnosing HRVs were 0.797, 0.757, 0.834, and 0.804, respectively. The Baveno VI criteria assessed by 2D-SWE spared 25.4% of EGD screenings and missed 2.4% of the HRV patients. Combining SPD ≤11.1 cm with the Baveno VI criteria could spare more EGD screenings than just applying the Baveno VI criteria (45.1% vs 25.4%, P < 0.001), and missed 4.9% of the HRV patients. The Baveno VI criteria assessed by 2D-SWE could be safely applied in cACLD patients to rule out HRV patients. The combined model Baveno VI/SPD could safely and significantly increase the rate of spared EGD.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:24Esophageal Varices-I: Introduction