Author information
1
Sezione di Gastroenterologia e Epatologia, Di.Bi.M.I.S, Università di Palermo, Italia. Electronic address: salvatore.petta@unipa.it.
2
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal QC, Canada.
3
Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy.
4
Hepatology Unit, Ospedale San Giuseppe, University of Milan, Milan, Italy.
5
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
6
Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland.
7
Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Italy.
8
Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom & Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
9
Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Italy; Research Center DENOTHE, University of Florence, Italy.
10
Sezione di Gastroenterologia e Epatologia, Di.Bi.M.I.S, Università di Palermo, Italia.
11
Centre d'Investigation de la Fibrose Hépatique, INSERM U1053, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France.
Abstract
BACKGROUND/AIM:
Baveno VI and expanded Baveno VI criteria can avoid the need for esophagogastroduodenoscopy(EGD) to screen for varices needing treatment(VNT) in a substantial proportion of compensated patients with viral and/or alcoholic cirrhosis. This multicenter, cross-sectional study aims to validate these criteria in patients with compensated cirrhosis due to nonalcoholic fatty liver disease(NAFLD), accounting for possible differences in liver stiffness measurement(LSM) values between M and XL probes.
MATERIALS/METHODS:
We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within 6 months of a reliable LSM measured by FibroScan® using M and/or XL probe. Baveno VI and expanded Baveno VI criteria were tested. The main variable used to optimize criteria was the percentage of endoscopies spared, keeping the risk of missing large VNT below a <5% threshold.
RESULTS:
314 patients had LSM by both M and XL probes(training set), while 338 and 138 by only M or XL probe, respectively(validation sets). In the training set use of Baveno VI and expanded Baveno VI criteria reduced by 33.3% and by 58% the number of EGD, missing 0.9% and 3.8% of large OV, respectively. The best thresholds to rule-out VNT were identified at PLT>110,000 and LSM<30 KPa for M probe, and PLT>110,000 and LSM<25 KPa for XL probe(NAFLD cirrhosis criteria). Usage of NAFLD cirrhosis criteria would have thus led to an absolute reduction in the number of EGD screened patients of 34.7% and 10.5% with respect to BAVENO VI and expanded BAVENO VI criteria respectively.
CONCLUSION:
The new NAFLD cirrhosis criteria, established for the FibroScan probe, can reduce by more than half the use of EGD to screen for VNT in NAFLD cirrhosis, with a chance of missing VNT below 5%.
LAY OF SUMMARY:
In NAFLD-related compensated cirrhosis expanded Baveno VI works better than Baveno VI criteria for ruling out the presence of VNT, sparing more unnecessary EGD. New NAFLD-cirrhosis criteria always based on LSM and PLT values and optimized for M and XL FibroScan probes, work better than Baveno VI and extended Baveno VI criteria. The accuracy of noninvasive scores for VNT is lower in nonobese patients.