Baveno VII Criteria for the Exclusion of Esophageal Varices in a Peruvian Population: Cross-Sectional Study
DOI:
https://doi.org/10.22516/25007440.1156Keywords:
Esophageal varices, Gastrointestinal endoscopy, Liver Cirrhosis, portal hypertensionAbstract
Introduction: Esophageal varices represent one of the main complications in patients with liver cirrhosis. The main objective was to determine the diagnostic performance of the new Baveno VII criteria to exclude the presence of esophageal varices in compensated advanced chronic liver disease (cACLD), in an independent Peruvian population.
Materials and methods: A cross-sectional study, including patients with cACLD, upper digestive endoscopy, and transient hepatic elastography from January 2017 to December 2019.
Results: The mean age was 59.4 (12.9) years, while the mean measurement of liver stiffness was 27.21 (14.6) kPa. The prevalence of esophageal varices was 85.6%; non-alcoholic fatty liver disease (NAFLD) (63.6%) was the most prevalent etiology, followed by viral hepatitis (14.4%). For esophageal varices exclusion, Baveno VII criteria for all etiologies demonstrated adequate sensitivity and negative predictive value (sensitivity: 96.7%; 95% confidence interval [CI]: 92.3%-98.8%; negative predictive value: 76.9%, 95% CI: 56.4% -91%). However, better diagnostic performance was found when applying the Baveno VII criteria without considering NAFLD patients (sensitivity: 98.4%, 95% CI: 79.2% -99.2%; negative predictive value: 90.9%, 95% CI: 79.2% -99.2%). This would prevent 14% of endoscopic studies with a 9% risk of failing to detect esophageal varices.
Conclusions: The Baveno VII criteria present good diagnostic performance for the exclusion of esophageal varices, especially in patients with cACLD without NAFLD, in an independent Peruvian population.
Downloads
References
Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151-171. https://doi.org/10.1016/j.jhep.2018.09.014
Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014;12:145. https://doi.org/10.1186/s12916-014-0145-y
Malpica-Castillo A, Ticse R, Salazar-Quiñones M, Cheng-Zárate L, Valenzuela-Granados V, Huerta-Mercado TJ. Mortalidad y readmisión en pacientes cirróticos hospitalizados en un hospital general de Lima, Perú. Rev Gastroenterol Perú. 2013;33(4):301-305.
Bustíos C, Dávalos M, Román R, Zumaeta E. Características Epidemiológicas y Clínicas de la Cirrosis Hepática en la Unidad de Hígado del HNERM Es-Salud. Rev Gastroenterol Perú. 2007;27(3):238-245.
Garcia-Tsao G, Bosch J. Management of Varices and Variceal Hemorrhage in Cirrhosis. N Engl J Med. 2010;362(9):823-32. https://doi.org/10.1056/NEJMra0901512
Bosch J, Abraldes JG, Berzigotti A, Garcia-Pagan JC. Portal hypertension and gastrointestinal bleeding. Semin Liver Dis. 2008;28(1):3-25. https://doi.org/10.1055/s-2008-1040318
Mauro E, Gadano A. What’s new in portal hypertension? Liver Int. 2020;40 Suppl 1:122-127. https://doi.org/10.1111/liv.14366
Bochnakova T. Hepatic Venous Pressure Gradient. Clin Liver Dis (Hoboken). 2021;17(3):144-148. https://doi.org/10.1002/cld.1031
Sauerbruch T, Schierwagen R, Trebicka J. Managing portal hypertension in patients with liver cirrhosis. F1000Res. 2018;7:F1000 Faculty Rev-533. https://doi.org/10.12688/f1000research.13943.1
Ripoll C. Hepatic Venous Pressure Gradient and Outcomes in Cirrhosis. J Clin Gastroenterol. 2007;41(3):S330-5. https://doi.org/10.1097/MCG.0b013e318150d0f4
D’Amico G, Pasta L, Morabito A, D’Amico M, Caltagirone M, Malizia G, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther. 2014;39(10):1180-93. https://doi.org/10.1111/apt.12721
Friedrich-Rust M, Poynard T, Castera L. Critical comparison of elastography methods to assess chronic liver disease. Nat Rev Gastroenterol Hepatol. 2016;13(7):402-11. https://doi.org/10.1038/nrgastro.2016.86
Pons M, Augustin S, Scheiner B, Guillaume M, Rosselli M, Rodrigues SG, et al. Noninvasive Diagnosis of Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease. Am J Gastroenterol. 2021;116(4):723-732. https://doi.org/10.14309/ajg.0000000000000994
Buechter M, Kahraman A, Manka P, Gerken G, Jochum C, Canbay A, et al. Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding. Digestion. 2016;94(3):138-144. https://doi.org/10.1159/000450704
Llop E, Berzigotti A, Reig M, Erice E, Reverter E, Seijo S, et al. Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors. J Hepatol. 2012;56(1):103-8. https://doi.org/10.1016/j.jhep.2011.06.027
Sporea I, Raţiu I, Sirli R, Popescu A, Bota S. Value of transient elastography for the prediction of variceal bleeding. World J Gastroenterol. 2011;17(17):2206-10. https://doi.org/10.3748/wjg.v17.i17.2206
Kazemi F, Kettaneh A, N’kontchou G, Pinto E, Ganne-Carrie N, Trinchet JC, et al. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol. 2006;45(2):230-5. https://doi.org/10.1016/j.jhep.2006.04.006
Stenberg Ribeiro M, Hagström H, Stål P, Ajne G. Transient liver elastography in normal pregnancy - a longitudinal cohort study. Scand J Gastroenterol. 2019;54(6):761-765. https://doi.org/10.1080/00365521.2019.1629007
Hu Z, Li Y, Li C, Huang C, Ou Z, Guo J, et al. Using Ultrasonic Transient Elastometry (FibroScan) to Predict Esophageal Varices in Patients with Viral Liver Cirrhosis. Ultrasound Med Biol. 2015;41(6):1530-7. https://doi.org/10.1016/j.ultrasmedbio.2015.02.005
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-974. https://doi.org/10.1016/j.jhep.2021.12.022
Eslam M, Sanyal AJ, George J, International Consensus Panel. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020;158(7):1999-2014.e1. https://doi.org/10.1053/j.gastro.2019.11.312
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee of American Association for Study of Liver Diseases; Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102(9):2086-102. https://doi.org/10.1111/j.1572-0241.2007.01481.x
Montes Ramirez ML, Pascual-Pareja JF, Sánchez-Conde M, Bernardino De la Serna JI, Zamora Vargas FX, Miralles P, et al. Transient elastography to rule out esophageal varices and portal hypertensive gastropathy in HIV-infected individuals with liver cirrhosis. Aids. 2012;26(14):1807–12. https://doi.org/10.1097/QAD.0b013e3283573267
Gaete MI, Díaz LA, Arenas A, González K, Cattaneo M, Fuster F, 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(6):1427–34. https://doi.org/10.1111/liv.14373
Augustin S, Pons M, Maurice JB, Bureau C, Stefanescu H, Ney M, et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology. 2017;66(6):1980-8. https://doi.org/10.1002/hep.29363
Pinto Marques Souza de Oliveira C, Pinchemel Cotrim H, Arrese M. Nonalcoholic Fatty Liver Disease Risk Factors in Latin American Populations: Current Scenario and Perspectives. Clin Liver Dis (Hoboken). 2019;13(2):39-42. https://doi.org/10.1002/cld.759
Ferrusquía-Acosta J, Bassegoda O, Turco L, Reverter E, Pellone M, Bianchini M, et al. Agreement between wedged hepatic venous pressure and portal pressure in non-alcoholic steatohepatitis-related cirrhosis. J Hepatol. 2021;74(4):811–8. https://doi.org/10.1016/j.jhep.2020.10.003
Bassegoda O, Olivas P, Turco L, Mandorfer M, Serra-Burriel M, Tellez L, et al. Decompensation in Advanced Nonalcoholic Fatty Liver Disease May Occur at Lower Hepatic Venous Pressure Gradient Levels Than in Patients With Viral Disease. Clin Gastroenterol Hepatol. 2022;20(10):2276-2286.e6. https://doi.org/10.1016/j.cgh.2021.10.023
Tapper EB, Loomba R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD. Nat Rev Gastroenterol Hepatol. 2018;15(5):274-82. https://doi.org/10.1038/nrgastro.2018.10
Sourianarayanane A, Talluri J, Humar A, McCullough AJ. Stage of fibrosis and portal pressure correlation in nonalcoholic steatohepatitis. Eur J Gastroenterol Hepatol. 2017;29(5):516–23. https://doi.org/10.1097/MEG.0000000000000825
Baffy G, Bosch J. Overlooked subclinical portal hypertension in non-cirrhotic NAFLD: Is it real and how to measure it? J Hepatol. 2022;76(2):458-463. https://doi.org/10.1016/j.jhep.2021.09.029
Petta S, Maida M, Macaluso FS, Di Marco V, Cammà C, Cabibi D, et al. The severity of steatosis influences liver stiffness measurement in patients with nonalcoholic fatty liver disease. Hepatology. 2015;62(4):1101-10. https://doi.org/10.1002/hep.27844
Caussy C, Chen J, Alquiraish MH, Cepin S, Nguyen P, Hernandez C, et al. Association Between Obesity and Discordance in Fibrosis Stage Determination by Magnetic Resonance vs Transient Elastography in Patients with Nonalcoholic Liver Disease. Clin Gastroenterol Hepatol. 2018;16(12):1974-1982.e7. https://doi.org/10.1016/j.cgh.2017.10.037
Abraldes JG, Bureau C, Stefanescu H, Augustin S, Ney M, Blasco H, et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The “Anticipate” study. Hepatology. 2016;64(6):2173-2184. https://doi.org/10.1002/hep.28824
Galizzi HO, Couto CA, Taranto DOL, Araújo SIO, Vilela EG. Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease. Ann Hepatol. 2021;20:100229. https://doi.org/10.1016/j.aohep.2020.07.003
Petta S, Wong VWS, Cammà C, Hiriart JB, Wong GL, Marra F, et al. Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values. Hepatology. 2017;65(4):1145–55. https://doi.org/10.1002/hep.28843
Zhou JH, Cai JJ, She ZG, Li HL. Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World J Gastroenterol. 2019;25(11):1307-1326. https://doi.org/10.3748/wjg.v25.i11.1307
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista colombiana de Gastroenterología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
