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Allaire M, Thabut D. The applicability of Baveno criteria in the setting of hepatocellular carcinoma remains a controversy. J Gastroenterol Hepatol 2024; 39:211. [PMID: 37989255 DOI: 10.1111/jgh.16415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Affiliation(s)
- M Allaire
- Service d'Hépato-gastroentérologie, Hôpital Universitaire Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France
- Genomic Instability, Metabolism, Immunity and Liver Tumorigenesis laboratory, Equipe Labellisée LIGUE 2023, Paris, France
- INSERM UMR 1138, Centre de recherche des Cordeliers, Paris, France
| | - D Thabut
- Service d'Hépato-gastroentérologie, Hôpital Universitaire Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Centre de recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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Allaire M, Campion B, Demory A, Larrey E, Wagner M, Rudler M, Roux C, Blaise L, Carrie NG, Thabut D. Baveno VI and VII criteria are not suitable for screening for large varices or clinically significant portal hypertension in patients with hepatocellular carcinoma. Aliment Pharmacol Ther 2023; 58:346-356. [PMID: 37300315 DOI: 10.1111/apt.17599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/11/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Baveno VI and VII criteria are used in patients with cirrhosis to rule out large size oesophageal varices (EV) and rule in/out clinically significant portal hypertension (CSPH). AIM To evaluate their diagnostic performance in these patients. METHODS We retrospectively included all patients with Child-Pugh A cirrhosis and HCC who had endoscopy, liver stiffness measurement (LSM) and platelet count within 6 months. They were classified according to the BCLC stage. Favourable Baveno VI criteria were defined by LSM < 20 kPa and platelets > 150 G/L (to rule out large EV), favourable Baveno VII criteria if LSM ≤ 15 kPa and platelets ≥ 150 G/L (to rule out CSPH, which was defined by a HVPG ≥ 10 mm Hg. RESULTS We included 185 patients; 46% were BCLC-0/A, 28% BCLC-B and 26% BCLC-C. EV were present in 44% (23% large), and HVPG ≥ 10 mm Hg in 42% (mean 8 mm Hg). In patients with favourable Baveno VI criteria, 8% of the whole cohort (Se 93%, NPV 92%), 11% of BCLC-0-A (Se 89%, NPV 89%) and 10.0% of BCLC-C patients (Se 91%, NPV 90%) had large EV. Among patients with HVPG < 10 mm Hg, 6% had large EV and 17% small. CSPH was present in 23% of patients with favourable Baveno VII criteria among the whole cohort, and in 25% of those with BCLC-0/A. The specificity of LSM ≥ 25 kPa to rule in CSPH was 48%. CONCLUSIONS Favourable Baveno VI criteria are not appropriate to rule out the presence of high-risk EV, or Baveno VII criteria to rule CSPH in/out in patients with HCC.
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Affiliation(s)
- Manon Allaire
- Service d'Hépato-Gastroentérologie, AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
- Centre de Recherche des Cordeliers, INSERM UMR 1138, Paris, France
| | - Bertille Campion
- Service d'Hépato-Gastroentérologie, AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Alix Demory
- Service d'Hépatologie, AP-HP Sorbonne Paris Nord, Hôpitaux Universitaire Paris Seine Saint-Denis, Bobigny, France
| | - Edouard Larrey
- Service d'Hépato-Gastroentérologie, AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Mathilde Wagner
- Service de Radiologie Diagnostique, AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Marika Rudler
- Service d'Hépato-Gastroentérologie, AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Charles Roux
- Service de Radiologie Interventionnelle, AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Lorraine Blaise
- Service d'Hépatologie, AP-HP Sorbonne Paris Nord, Hôpitaux Universitaire Paris Seine Saint-Denis, Bobigny, France
| | - Nathalie G Carrie
- Centre de Recherche des Cordeliers, INSERM UMR 1138, Paris, France
- Service d'Hépatologie, AP-HP Sorbonne Paris Nord, Hôpitaux Universitaire Paris Seine Saint-Denis, Bobigny, France
| | - Dominique Thabut
- Service d'Hépato-Gastroentérologie, AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
- Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, INSERM, Paris, France
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Wu CWK, Lui RNS, Wong VWS, Yam TF, Yip TCF, Liu K, Lai JCT, Tse YK, Mok TSK, Chan HLY, Ng KKC, Wong GLH, Chan SL. Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15092480. [PMID: 37173947 PMCID: PMC10177352 DOI: 10.3390/cancers15092480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
The Baveno VII criteria are used in patients with liver cirrhosis to predict high-risk varices in patients with liver cirrhosis. Yet its use in patients with advanced hepatocellular carcinoma (HCC) has not been validated. HCC alone is accompanied with a higher variceal bleeding risk due to its association with liver cirrhosis and portal vein thrombosis. The use of systemic therapy in advanced HCC has been thought to further augment this risk. Upper endoscopy is commonly used to evaluate for the presence of varices before initiation of treatment with systemic therapy. Yet it is associated with procedural risks, waiting time and limited availability in some localities which may delay the commencement of systemic therapy. Our study successfully validated the Baveno VI criteria with a 3.5% varices needing treatment (VNT) missed rate, also with acceptable <5% VNT missed rates when considering alternative liver stiffness (LSM) and platelet cut-offs. The Baveno VII clinically significant portal hypertension rule-out criteria (LSM < 15 kPa and platelet >150 × 109/L) also revealed a low frequency (2%) of hepatic events, whilst the rule-in criteria (LSM > 25 kPa) was predictive of a higher proportion of hepatic events (14%). Therefore, our study has successfully validated the Baveno VII criteria as a non-invasive stratification of the risk of variceal bleeding and hepatic decompensation in the HCC population.
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Affiliation(s)
- Claudia Wing-Kwan Wu
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Rashid Nok-Shun Lui
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Tsz-Fai Yam
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Terry Cheuk-Fung Yip
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Jimmy Che-To Lai
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yee-Kit Tse
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Tony Shu-Kam Mok
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Hong Kong Cancer Institute, Hong Kong SAR, China
| | - Henry Lik-Yuen Chan
- Medical Data Analytics Centre, Hong Kong SAR, China
- Union Hospital, Hong Kong SAR, China
| | - Kelvin Kwok-Chai Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Lai-Hung Wong
- Medical Data Analytics Centre, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Institute of Digestive Disease, Prince of Wales Hospital, Hong Kong SAR, China
| | - Stephen Lam Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Hong Kong Cancer Institute, Hong Kong SAR, China
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Corpechot C. Noninvasive Evaluation of Fibrosis and Portal Hypertension in Primary Biliary Cholangitis. Clin Liver Dis 2022; 26:681-689. [PMID: 36270723 DOI: 10.1016/j.cld.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease that, if left untreated or insufficiently treated, inexorably progresses toward cirrhosis and its potentially fatal complications. Alongside with the biochemical response to ursodeoxycholic acid therapy, advanced liver fibrosis and portal hypertension (PH) were shown to be major prognostic determinants in PBC. Therefore, one of the goals of noninvasive PBC evaluation should be to early diagnose compensated advanced disease and/or clinically significant PH. In this article, the main methods of noninvasive assessment of liver fibrosis and PH in PBC, and their clinical relevance, will be reviewed.
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Affiliation(s)
- Christophe Corpechot
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, French network for rare liver diseases FILFOIE, European Reference Network ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Inserm UMR_S938, Saint-Antoine Research Center (CRSA), Sorbonne University, 184 rue du Faubourg Saint-Antoine, Paris 75571 Cedex 12, France.
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Fofiu R, Bende F, Popescu A, Șirli R, Miuţescu B, Sporea I. Assessing Baveno VI Criteria Using Liver Stiffness Measured with a 2D-Shear Wave Elastography Technique. Diagnostics (Basel) 2021; 11:diagnostics11050737. [PMID: 33919033 PMCID: PMC8142982 DOI: 10.3390/diagnostics11050737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
The present study evaluates the performance of Baveno VI criteria, using liver stiffness (LS) assessed with a 2D-SWE elastography technique, for predicting high-risk varices (HRV) in patients with compensated advanced chronic liver disease (cACLD). A secondary aim was to determine whether the use of spleen stiffness measurements (SSMs), as additional criteria, increases the performance of the 2D-SWE Baveno VI criteria. Data were collected from 208 subjects with cACLD, who underwent abdominal ultrasound, liver and spleen stiffness measurements, and upper digestive endoscopy. HRV were defined as grade 1 esophageal varices (EV) with red wale marks, grade 2/3 EV, and gastric varices. A total of 35.6% (74/208) of the included subjects had HRV. The optimal LS cut-off value for predicting HRV was 12 kPa (AUROC-0.80). Using both LS cut-off value < 12 kPa and a platelet cut-off value > 150 × 109 cells/L as criteria to exclude HRV, 52/208 (25%) subjects were selected, 88.5% (46/52) were without EV, 9.6% (5/52) had grade 1 EV, and 1.9% (1/52) had HRV. Thus 98% of the subjects were correctly classified as having or not having HRV and 25% of the surveillance endoscopies could have been avoided. Using SS < 13.2 kPa and a platelet cut-off value > 150 × 109 cells/L as additional criteria for the patients that were outside the initial ones, 32.7% of the surveillance endoscopies could have been avoided.
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Abstract
Although endoscopy is the recommended method for detecting esophageal varices, noninvasive methods for diagnosing esophageal varices are needed to avoid unnecessary invasive endoscopic examinations. In recent years, many studies have been performed to predict the presence of high-risk varices in noninvasive ways. The most widely used tools for noninvasive screening for esophageal varices are the Baveno VI and expanded Baveno VI criteria. Even these accepted criteria are not 100% accurate and have some limitations. Here, we summarize the current literature on the noninvasive diagnosis of esophageal varices in liver cirrhosis patients and highlight the remaining issues.
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Affiliation(s)
- Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Ryotaro Sakamori
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Mogawer S, Morad H, Sherif H, Ramadan N, Aziz AA. Revising the criteria for the predictors of variceal haemorrhage outcome. Arab J Gastroenterol 2014; 14:154-7. [PMID: 24433644 DOI: 10.1016/j.ajg.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 09/06/2013] [Accepted: 10/01/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND STUDY AIMS There are many criteria and definitions used to evaluate the failure to control and prevent variceal bleeding. Baveno criteria were developed in Baveno consensus workshops I-III. Some of these criteria are fairly difficult to apply and do not adequately reflect common situations that are observed in clinical practice. Therefore, new criteria were developed at the Baveno-IV workshop. In the present study, we aimed to evaluate the validity of Baveno II-IV criteria in the prediction of bleeding recurrence among patients with liver cirrhosis who presented with bleeding oesophageal varices. PATIENTS AND METHODS Fifty patients with liver cirrhosis and acute variceal bleeding were divided into two groups according to treatment response. Group I consisted of 44 patients for whom treatment to control bleeding was successful, and Group II included 6 patients for whom treatment failed. Baveno criteria were used in the evaluation of treatment outcome in these patients. RESULTS The overall accuracy of Baveno II and III criteria was 87.3% within the first 6h and 76.5% after 6h, with a mean accuracy 81.9%. The overall accuracy of Baveno IV criteria in this study was 83%. The criterion of death was also very specific (100%), with 100% PPV, but its sensitivity was very low (16.7%). CONCLUSION Baveno IV criteria are less complicated, much easier to apply and have nearly the same accuracy as Baveno II/III criteria. However, there are some criteria that need to be modified, such as the adjusted blood requirement index (ABR1), among others.
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Affiliation(s)
| | - Heba Morad
- Faculty of Medicine, Cairo University, Egypt
| | - Heba Sherif
- Faculty of Medicine, Cairo University, Egypt
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