The Baveno VI criteria for predicting esophageal varices: validation in real life practice

• Mafalda Sousa ^[1] ; Sónia Fernandes ^[1] ; Luísa Proença ^[1] ; Ana Paula Silva ^[1] ; Sónia Leite ^[1] ; Joana Silva ^[1] ; Ana Ponte ^[1] ; Jaime Rodrigues ^[1] ; João Carlos Silva ^[1] ; João Carvalho ^[1]
  1. [1] Centro Hospitalar de Vila Nova de Gaia

     Centro Hospitalar de Vila Nova de Gaia

     Gaia, Portugal

     
• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 109, Nº. 10, 2017, págs. 704-707
• Idioma: inglés
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• Resumen

  • Background and aims: According to the Baveno VI consensus, patients with liver stiffness < 20 kPa and a platelet count > 150,000 ul have very low risk of clinically significant varices and do not need a screening endoscopy. The aim of this study was to evaluate non-invasive methods as predictors of esophageal varices according to the Baveno VI recommendations, in real life clinical practice. Methods: Retrospective evaluation of patients with chronic liver disease who underwent transient elastography between January 2013 and December 2015. Results: One hundred and four patients were included in the study, the median age was 56.8 years and 69.2% were male. The etiology of liver disease was hepatitis C in 80% of patients (including 20% with HIV co-infection), alcohol in 12%, hepatitis B in 4% and other causes in 5%. Varices were present in 25% of patients. A liver stiffness < 20 kPa had a sensitivity of 92.3% and a specificity of 84.6%. When considering high risk varices (small with red wales or large varices), a liver stiffness < 20 kPa had 100% sensitivity. A platelet count > 150,000/l had a sensitivity of 84.6% and a specificity of 64.1%. Four patients with a platelet count (PLT) > 150,000/l had esophageal varices. When both criteria were applied to the patient cohort, according to the Baveno VI consensus, the sensitivity was 100% and the specificity, 61.5%. Conclusion: In this study, the Baveno VI criteria had 100% sensitivity but a relatively low specificity for the non-invasive diagnosis of esophageal varices. In clinical practice, all patients with varices are identified but many patients have a subsequent negative endoscopy.