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Predicting Esophageal Varices and Varices Needing Treatment in Compensated Advanced Chronic Liver Disease

  • 0Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. rthandassery@uams.edu.
Digestive Diseases and Sciences +

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July 3, 2025

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July 3, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Baveno VI criteria (BC) and expanded BC (EBC) effectively identify patients with compensated advanced chronic liver disease (cACLD) who need treatment for esophageal varices (EV). These noninvasive scores can help spare patients from unnecessary endoscopies while maintaining high accuracy.

Area Of Science

  • Hepatology
  • Gastroenterology
  • Diagnostic Accuracy

Background

  • Compensated advanced chronic liver disease (cACLD) carries a risk of gastroesophageal varices.
  • Noninvasive scoring systems aim to identify patients with cACLD who require endoscopic screening for clinically significant portal hypertension (CSPH).
  • Comparative data on the accuracy of these scores for predicting CSPH, specifically esophageal varices (EV) and varices needing treatment (VNT), are limited.

Purpose Of The Study

  • To directly compare the diagnostic accuracy of various noninvasive scoring systems for predicting CSPH (EV and VNT) in patients with cACLD.
  • To evaluate the ability of Baveno VI criteria (BC) and expanded BC (EBC) to spare patients from esophagogastroduodenoscopy (EGD).

Main Methods

  • A cohort of patients with cACLD was assessed.
  • The predictive performance of Baveno VI criteria (BC), expanded BC (EBC), AST-Platelet Ratio Index, MELD-Na, liver stiffness measurement, FIB-4, CHESS-ALARM score, and FIB-5 score for EV and VNT was compared.
  • The rate of esophagogastroduodenoscopy (EGD) avoidance and miss rates for EV and VNT were calculated.

Main Results

  • BC and EBC demonstrated accuracy in identifying patients with EV, gastric varices (GV), and VNT.
  • BC allowed EGD sparing in 48% of patients with a 6.4% miss rate for EV; EBC spared EGD in 60% with a 0% miss rate for VNT.
  • BC, EBC, CHESS-ALARM score, and FIB-5 score independently predicted EV and VNT, with similar performance across metabolic dysfunction-associated steatotic liver disease (MASLD) and non-MASLD groups, as well as in obese and nonobese subgroups.

Conclusions

  • BC and EBC are valuable tools for sparing EGD in patients with cACLD, offering low miss rates for EV, GV, and VNT.
  • The performance of BC and EBC was consistent regardless of MASLD status or obesity.
  • CHESS-ALARM score and FIB-5 score show high accuracy in predicting CSPH (EV and VNT) in patients with cACLD.

Keywords:

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