J Korean Med Sci.  2020 Aug;35(30):e249. 10.3346/jkms.2020.35.e249.

Application of Baveno Criteria and Modified Baveno Criteria with Shear-wave Elastography in Compensated Advanced Chronic Liver Disease

• Kang SH
• Baik SK
• Kim MY

• KMID: 2505191
• DOI: http://doi.org/10.3346/jkms.2020.35.e249

Abstract

Background
We aimed to validate Baveno VI and expanded Baveno VI criteria using two dimensional shear-wave elastography (2D-SWE) in compensated advanced chronic liver disease (cACLD) patients with alcohol as the main etiology.
Methods
Clinical data from 305 patients with cACLD who underwent a liver stiffness measurement (LSM) with 2D-SWE and endoscopy were consecutively collected.
Results
Among 305 patients, high-risk varix (HRV) was identified in 21.3% (n = 65). The main etiology was alcoholic liver disease (51.8%), followed by hepatitis B virus (29.8%) and hepatitis C virus (9.1%). Baveno VI criteria spared endoscopy in 118 of the 305 (38.7%) patients, and 7 (5.9%) were missed with HRV. Expanded Baveno VI criteria spared more endoscopies (60.0%), but missed more HRV (9.8%) compared with Baveno VI criteria. The other classification described as the modified Baveno VI criteria were LSM < 25 kPa and PLT ≥ 150 × 103/mm3. In total, 131 of the 305 (43.0%) patients were within the modified Baveno VI criteria, of whom seven (5.3%) had missed HRV. After adding spleen diameter < 12 cm to the modified Baveno VI criteria, the number of spared endoscopies increased by 106/305 (34.8%), with three (2.8%) presenting with HRV, indicating a risk of missing HRV.
Conclusion
Baveno VI and expanded Baveno VI criteria with 2D-SWE were insufficient with an HRV miss rate of over 5%. The modified Baveno VI criteria with spleen diameters < 12 cm with 2D-SWE spared more endoscopies with a minimal risk of missing HRV in cACLD patients with alcohol as the main etiology.

Keyword

Cirrhosis; Esophageal Varices; Baveno VI Criteria; Shear-wave Elastography

Figure

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  Fig. 1 Patient flow diagram.US = ultrasound, 2D-SWE = 2 dimensional shear-wave elastography, SWE = shear-wave elastography, AST = aspartate aminotransferase, ALT = alanine aminotransferase, UNL = IQR = interquartile range, LSM = liver stiffness measurement, HRV = high-risk varix.

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