Baveno Criteria Spare Endoscopies Among Patients With Compensated Cirrhosis Within a Large US Healthcare System

The Baveno criteria have been validated in populations outside of the United States and have been shown to accurately rule out clinically significant portal hypertension (CSPH) and high-risk varices. The criteria have been adopted by European and US guidelines. We aim to evaluate the performance characteristics of the Baveno VI criteria in a large US healthcare system.

Patients evaluated within Kaiser Permanente Northern California with cirrhosis (liver stiffness measurement ≥10 kPa) who underwent a FibroScan between 2016 and 2022 and an upper endoscopy within 12 months were included. Endoscopic and imaging findings were assessed. We evaluated the performance characteristics of the Baveno VI criteria for ruling out CSPH based on endoscopic and radiologic evidence consistent with CSPH.

Among 428 patients, the sensitivity of the Baveno VI criteria for ruling out CSPH was determined to be 84.8%. The sensitivity for identifying medium/large varices was 95.1%. Applying Baveno criteria would spare 90 endoscopies.

Application of the Baveno criteria spares 21% of unnecessary endoscopies with a low risk of missing high-risk varices, confirming that the Baveno criteria can be confidently adopted in the United States to rule out CSPH.