Validation of Baveno VI Criteria for Screening of Esophageal Varices in a Cohort of South Asian Patients with Compensated Chronic Liver Disease

Abstract

Objectives: A patient with liver stiffness by Vibration controlled Transient elastography(TE) <20 kPa and a platelet count >150,000/mm3 does not require screening endoscopy according to Baveno VI consensus. The Baveno consensus statement on esophageal varices screening has not been validated in the South Asian population. TE may not be widely available in resource limited areas. We tried to see whether easily available parameters could be used to predict high risk varices(HRV).

Method: A cross-sectional study evaluating patients with liver stiffness >10 kPa who had endoscopy within 6 months of TE evaluation.

Results: 375 patients who underwent TE and upper GI endoscopy over one year were included. Commonest etiology was HBV(42 %) followed by Hepatitis C(39%), NAFLD(9.1%) and alcohol(9%). 262 of the 266 patients satisfying Baveno VI consensus criteria for avoiding screening endoscopy did not have HRV. Sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) was 96 %, 90 %, 74% and 99 % respectively and (AUC = 0.91). By using MELD 6 or MELD < 8 and platelet >150000/mm3 criteria, 67% endoscopies could have been circumvented. Using Baveno VI criteria, 70% endoscopies could have been circumvented.

Conclusion: This study validates the Baveno VI consensus statement on esophageal variceal screening in cirrhosis, in a South Asian population. It also describes a new strategy using MELD 6 or MELD < 8 and platelet > 150000/mm3 in areas with limited resources where TE is not widely available.