Skip to main content
SpringerLink
Log in

Baveno criteria perform better than expanded Baveno and Rete Sicilia Selezione Terapia–Hepatitis C virus criteria for predicting varices needing treatment

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aims

Endoscopy is the gold standard for the detection and staging of varices. Baveno, expanded Baveno, and Rete Sicilia Selezione Terapia–hepatitis C virus (RESIST-HCV) criteria predict varices non-invasively in patients with cirrhosis. We assessed the performance of these criteria for predicting varices needing treatment (VNT).

Methods

Consecutive patients with compensated cirrhosis due to viral etiologies evaluated between January 2014 and May 2017 were included in this retrospective analysis of a prospectively maintained database. VNTs were defined as either large varies or small varices with red color signs on endoscopy. Performance characteristics to predict VNTs were estimated for the three criteria and spared endoscopy rate (SER) and missed VNT rates were determined.

Results

Two hundred and ninety-five treatment-naïve cirrhosis patients, etiology hepatitis B (n = 154) or hepatitis C (n = 141), mean age 43.1 ± 13.2 years, 127 (43.1%) males were included. The median liver stiffness measurement (LSM) and platelet counts were 19.7 (interquartile range [IQR]: 14.8–28.8) kPa and 119 (IQR: 80–160) × 103/mm3, respectively. The SER and missed VNT rates were as follows—for Baveno criteria: 18.3% and 6.2%; expanded Baveno: 35.3% and 29.2%; and for RESIST-HCV criteria: 37.3% and 22.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 93.7%, 21.9%, 18.9%, and 94.7% for Baveno criteria; 70.8%, 42.3%, 19.3%, and 88.1% for expanded Baveno; and 77.1%, 44.5%, 21.3%, and 90.9% for RESIST-HCV criteria, respectively.

Conclusion

Baveno criteria are useful to avoid screening endoscopies in patients with cirrhosis of viral etiologies. In contrast, although expanded Baveno criteria and RESIST-HCV criteria spare more endoscopies, a high missed VNT rate limits their applicability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. D’Amico G. Esophageal varices: from appearance to rupture; natural history and prognostic indicators. In: Groszmann RJ, Bosch J, eds. Portal Hypertension in the 21st Century. Dordrecht: Springer Netherlands; 2004. pp. 147–54.

  2. Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353:2254–61.

    Article  CAS  Google Scholar 

  3. Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266–72.

    Article  Google Scholar 

  4. Zoli M, Merkel C, Magalotti D, et al. Natural history of cirrhotic patients with small esophageal varices: a prospective study. Am J Gastroenterol. 2000;95:503–8.

    Article  CAS  Google Scholar 

  5. Merkel C, Marin R, Angeli P, et al. A placebo-controlled clinical trial of nadolol in the prophylaxis of growth of small esophageal varices in cirrhosis. Gastroenterology. 2004;127:476–84.

    Article  CAS  Google Scholar 

  6. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40:652–9.

    Article  Google Scholar 

  7. de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005;43:167–76.

    Article  Google Scholar 

  8. Rout G, Sharma S, Gunjan D, et al. Development and validation of a novel model for outcomes in patients with cirrhosis and acute Variceal bleeding. Dig Dis Sci. 2019;64:2327–37.

    Article  Google Scholar 

  9. Rout G, Shalimar, Gunjan D, et al. Thromboelastography-guided blood product transfusion in cirrhosis patients with variceal bleeding: a randomized controlled trial. J Clin Gastroenterol. 2020;54:255–62.

    Article  Google Scholar 

  10. Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–38.

    Article  CAS  Google Scholar 

  11. Hwang JH, Shergill AK, Acosta RD, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc. 2014;80:221–7.

    Article  Google Scholar 

  12. de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.

    Article  Google Scholar 

  13. Calès P, Desmorat H, Vinel JP, et al. Incidence of large oesophageal varices in patients with cirrhosis: application to prophylaxis of first bleeding. Gut. 1990;31:1298–302.

    Article  Google Scholar 

  14. Spiegel BM, Targownik L, Dulai GS, Karsan HA, Gralnek IM. Endoscopic screening for esophageal varices in cirrhosis: Is it ever cost effective? Hepatology. 2003;37:366-77.

  15. Maurice JB, Brodkin E, Arnold F, et al. Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices. J Hepatol. 2016;65:899–905.

    Article  Google Scholar 

  16. Perazzo H, Fernandes FF, Castro Filho EC, Perez RM. Points to be considered when using transient elastography for diagnosis of portal hypertension according to the Baveno’s VI consensus. J Hepatol. 2015;63:1048–9.

    Article  Google Scholar 

  17. Augustin S, Pons M, Genesca J. Validating the Baveno VI recommendations for screening varices. J Hepatol. 2017;66:459–60.

    Article  Google Scholar 

  18. Augustin S, Pons M, Maurice JB, et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology. 2017;66:1980–8.

    Article  Google Scholar 

  19. Chang PE, Tan CK, Cheah CC, Li W, Chow WC, Wong YJ.  Validation of the expanded Baveno-VI criteria for screening gastroscopy in Asian patients with compensated advanced chronic liver disease. Dig Dis Sci. 2021;66:1343-8.

  20. Stafylidou M, Paschos P, Katsoula A, et al. Performance of Baveno VI and expanded Baveno VI criteria for excluding high-risk varices in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17:1744–1755.e11.

    Article  Google Scholar 

  21. Calvaruso V, Cacciola I, Licata A, et al. Is transient elastography needed for noninvasive assessment of high-risk varices? The REAL Experience. Am J Gastroenterol. 2019;114:1275–82.

    Article  Google Scholar 

  22. Bonder A, Afdhal N. Utilization of FibroScan in clinical practice. Curr Gastroenterol Rep. 2014;16:372.

    Article  Google Scholar 

  23. Brown JJ, Naylor MJ, Yagan N. Imaging of hepatic cirrhosis. Radiology. 1997;202:1–16.

    Article  CAS  Google Scholar 

  24. Goyal R, Mallick SR, Mahanta M, et al. Fibroscan can avoid liver biopsy in Indian patients with chronic hepatitis B. J Gastroenterol Hepatol. 2013;28:1738–45.

    Article  CAS  Google Scholar 

  25. Armstrong MJ, Corbett C, Hodson J, et al. Operator training requirements and diagnostic accuracy of Fibroscan in routine clinical practice. Postgrad Med J. 2013;89:685–92.

    Article  CAS  Google Scholar 

  26. Shalimar, Kumar R, Rout G, et al. Body mass index-based controlled attenuation parameter cut-offs for assessment of hepatic steatosis in non-alcoholic fatty liver disease. Indian J Gastroenterol. 2020;39:32–41. 

  27. Singh S, Muir AJ, Dieterich DT, Falck-Ytter YT. American Gastroenterological Association Institute technical review on the role of elastography in chronic liver diseases. Gastroenterology. 2017;152:1544–77.

    Article  Google Scholar 

  28. Szakács Z, Erőss B, Soós A, et al. Baveno criteria safely identify patients with compensated advanced chronic liver disease who can avoid variceal screening endoscopy: a diagnostic test accuracy meta-analysis. Front Physiol. 2019;10:1028.

    Article  Google Scholar 

  29. Bae J, Sinn DH, Kang W, et al. Validation of the Baveno VI and the expanded Baveno VI criteria to identify patients who could avoid screening endoscopy. Liver Int. 2018;38:1442–8.

    Article  Google Scholar 

  30. Calès P, Sacher-Huvelin S, Valla D, et al. Large oesophageal varice screening by a sequential algorithm using a cirrhosis blood test and optionally capsule endoscopy. Liver Int. 2018;38:84–93.

    Article  Google Scholar 

  31. Llop E, Lopez M, de la Revilla J, et al. Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease. J Gastroenterol Hepatol. 2017;32:1867–72.

    Article  Google Scholar 

  32. McDowell H, Tang K, Cash J, et al. PTH-098 Can baveno-VI criteria for varices screening safely reduce endoscopy workload in a regional liver unit? Gut. 2018;67:A127.

    Google Scholar 

  33. Gaete MI, Díaz LA, Arenas A, et al. Baveno VI and expanded Baveno VI criteria successfully predicts the absence of high-risk gastro-oesophageal varices in a Chilean cohort. Liver Int. 2020;40:1427–34.

    Article  Google Scholar 

  34. Calès P, Buisson F, Ravaioli F, et al. How to clarify the Baveno VI criteria for ruling out varices needing treatment by noninvasive tests. Liver Int. 2019;39:49–53.

    Article  Google Scholar 

  35. Abd Elrazek AE, Eid KA, El-Sherif AE, Abd El Al UM, El-Sherbiny SM, Bilasy SE. Screening esophagus during routine ultrasound: medical and cost benefits. Eur J Gastroenterol Hepatol. 2015;27:8–12.

  36. Lotfipour AK, Douek M, Shimoga SV, et al. The cost of screening esophageal varices: traditional endoscopy versus computed tomography. J Comput Assist Tomogr. 2014;38:963–7.

    Article  Google Scholar 

  37. Colli A, Gana JC, Turner D, et al. Capsule endoscopy for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis. Cochrane Database Syst Rev. 2014; 10:CD008760.

  38. Stefanescu H, Radu C, Procopet B, et al. Non-invasive ménage à trois for the prediction of high-risk varices: stepwise algorithm using lok score, liver and spleen stiffness. Liver Int. 2015;35:317–25.

    Article  Google Scholar 

Download references

Acknowledgments

Mr. Amar Negi and Miss Manisha Kumari for data maintenance.

Funding

This research was funded by Physicians Research Foundation (1189/19/RS/4542)- Dr. Shalimar. The funding agency was not involved in the conduct of the study and had no role in manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Ashish Agarwal, Piyush Pathak &  Shalimar

  2. Department of Gastroenterology and Hepatology, Dr. Rajendra Prasad Medical College, Kangra, Tanda 176 001, India

    Swatantra Gupta

  3. Department of Gastroenterology, All India Institute of Medical Sciences, Patna, 801 507, India

    Ramesh Kumar

Authors
  1. Ashish Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Piyush Pathak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Swatantra Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ramesh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shalimar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shalimar.

Ethics declarations

Conflict of interests

AA, PP, SG, RK, and S  declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Ethics approval

The study protocol was approved by the Institute Ethics committee (IEC-471/01.09.2017).

Patient consent

Patient consent was waived off as this was a retrospective analysis.

Disclaimer

The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwal, A., Pathak, P., Gupta, S. et al. Baveno criteria perform better than expanded Baveno and Rete Sicilia Selezione Terapia–Hepatitis C virus criteria for predicting varices needing treatment. Indian J Gastroenterol 40, 590–597 (2021). https://doi.org/10.1007/s12664-020-01141-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-020-01141-9

Keywords

Search

Navigation