Baveno VII Algorithm can be Used to Exclude Varices Needing Treatment in MASLD Related Compensated Advanced Chronic...

Baveno VII guidelines recommend avoiding screening esophagogastroduodenoscopy (EGD) in patients with compensated advanced chronic liver disease (cACLD) in patients with spleen stiffness ≤40 kPa among those patients who do not fulfil the Baveno VI criteria. We aimed to validate the performance of Baveno VII algorithm in patients with metabolic dysfunction-associated chronic liver disease (MASLD) related cACLD.

Consecutive patients of MASLD-related cACLD undergoing liver and spleen stiffness measurement (LSM and SSM) using a 100 Hz module and screening EGD within 1 month were prospectively enrolled.

From September 2021 to December 2022, 1051 patients were screened and 325 were enrolled for analysis. Overall, varices needing treatment (VNT) were seen in 104 (32%) patients. The Baveno VII compared to Baveno VI algorithm avoided more EGDs (31.4% vs. 18.5%, P < 0.001) with an acceptable miss rate (4.8% vs. 1.9%). Among diabetic patients, the EGD spare rate was higher in Baveno VII than Baveno VI (29.4% vs 18.1%, P = 0.02) with a miss rate of 5% vs. 3.3%. Among obese patients, EGD spare rate was (33.4% vs 22.5%, P = 0.009) with a miss rate of 3% vs.1.5%. Other models had miss VNT rates >5%, i.e., 8.7% expanded Baveno VI algorithm, 14.4% AST-platelet ratio index (APRI), 16.3% platelet-spleen ratio (PSR), 33.6% LS-spleen diameter to platelet ratio score (LSPS), 23.1% Fib-4 and 21.2% Rete Sicilia Selezione Terapia (RESIST) criteria.

The Baveno VII algorithm was superior to Baveno VI and other models in ruling out VNT in patients with MASLD-related cACLD, including those with diabetes and obesity.

Metabolic dysfunction associated chronic liver disease (MASLD) is one of the most common causes of liver cirrhosis worldwide. Upper gastrointestinal endoscopy is the standard for screening esophageal varices in patients with cirrhosis. Patients with MASLD satisfying the Baveno VII algorithm using the 100 Hz spleen-specific module can avoid the invasive endoscopy procedure with a very low probability of missing high-risk varices needing treatment.Clinical trial registration - NCT05044663.