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Evaluation of three "beyond Baveno VI" criteria to safely spare endoscopies in compensated advanced chronic liver disease.
- Source :
-
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver [Dig Liver Dis] 2019 Aug; Vol. 51 (8), pp. 1135-1140. Date of Electronic Publication: 2019 Jan 11. - Publication Year :
- 2019
-
Abstract
- Background: Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm <superscript>3</superscript> exclude varices needing treatment (VNT) in viral compensated advanced chronic liver disease (cACLD), saving-up to 20-25% endoscopies (Baveno VI criteria). Refinements of such criteria to further reduce endoscopies and an approach without LSM (Platelet 150/MELD 6) were later proposed.<br />Aims: To assess LSM 25/platelet 125, LSM 25/platelet 110 (Expanded-Baveno VI) and Platelet 150/MELD 6 accuracy versus Baveno VI criteria, and the impact of platelet count variability on criteria accuracy in all-etiologies cACLD.<br />Methods: cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year.<br />Results: Of 442 patients, 31% had varices (7% with VNT). Baveno VI criteria had 100% sensitivity (Se) and negative predictive value (NPV) and spared 19.5% endoscopies. "LSM 25/platelet 125" and "Expanded-Baveno VI" criteria maintained such accuracy, sparing 15% and 24% more endoscopies, respectively (p < 0.001). Platelet 150/MELD 6 was less accurate, misclassifying 10% VNT. Platelet count variability exceeded 8% and one VNT patient was misclassified with both "Expanded-Baveno VI" and "LSM 25/platelet 125" criteria considering the previous platelet count.<br />Conclusions: Both "Expanded-Baveno VI" and "LSM 25/platelet 125" criteria are accurate in cACLD, but the former are more advantageous. Platelet 150/MELD 6 proved inadequate.<br /> (Copyright © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Elasticity Imaging Techniques
Esophageal and Gastric Varices etiology
Female
Humans
Italy
Male
Middle Aged
Platelet Count
Retrospective Studies
Unnecessary Procedures
Young Adult
End Stage Liver Disease complications
Endoscopy, Gastrointestinal statistics & numerical data
Esophageal and Gastric Varices diagnosis
Patient Selection
Subjects
Details
- Language :
- English
- ISSN :
- 1878-3562
- Volume :
- 51
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
- Publication Type :
- Academic Journal
- Accession number :
- 30691777
- Full Text :
- https://doi.org/10.1016/j.dld.2018.12.025