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

Chitranshu Vashishtha1, Ankit Bhardwaj2, Shalini Thapar Laroia3

  • 1Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India.

Journal of Clinical and Experimental Hepatology
|July 28, 2026
PubMed

Insights

The Baveno VII algorithm effectively identifies patients with metabolic dysfunction-associated chronic liver disease (MASLD) who can safely avoid screening endoscopy. This approach reduces unnecessary procedures while maintaining a low miss rate for significant esophageal varices.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Medical Diagnostics

Background:

  • Metabolic dysfunction-associated chronic liver disease (MASLD) is a leading cause of cirrhosis globally.
  • Screening for esophageal varices via esophagogastroduodenoscopy (EGD) is standard for patients with advanced chronic liver disease (cACLD).
  • Baveno VII guidelines suggest avoiding EGD in certain cACLD patients with spleen stiffness ≤40 kPa.

Purpose of the Study:

  • To validate the Baveno VII algorithm's performance in MASLD-related cACLD patients.
  • To assess the algorithm's efficacy in reducing EGD procedures.
  • To evaluate the miss rate for varices needing treatment (VNT) within this specific patient cohort.

Main Methods:

  • Prospective enrollment of MASLD-related cACLD patients undergoing liver and spleen stiffness measurement (LSM/SSM) and EGD.
  • Utilized a 100 Hz spleen-specific module for stiffness measurements.
  • Compared Baveno VII algorithm performance against Baveno VI and other diagnostic models.

Main Results:

  • Baveno VII significantly increased EGD avoidance (31.4%) compared to Baveno VI (18.5%) with a low VNT miss rate (4.8%).
  • Higher EGD spare rates were observed in diabetic (29.4%) and obese (33.4%) patients using Baveno VII.
  • Other models like APRI, PSR, LSPS, Fib-4, and RESIST showed higher VNT miss rates (>5%).

Conclusions:

  • The Baveno VII algorithm demonstrates superiority over Baveno VI and other models for ruling out VNT in MASLD-related cACLD.
  • The algorithm is effective even in patients with comorbid diabetes and obesity.
  • MASLD patients meeting Baveno VII criteria can safely avoid invasive endoscopy, minimizing risks and healthcare costs.
Abstract

Keywords:
esophagogastroduodenoscopyliver stiffnessspleen stiffness

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