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Cited by 140Liver Disease and TransplantationLiver Disease Diagnosis and TreatmentEsophageal Cancer Research and Treatment

Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis

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Petta, Salvatore, Sebastiani, Giada, Bugianesi, Elisabetta, Viganò, Mauro, Wong, Vincent Wai-Sun, Berzigotti, Annalisa, Fracanzani, Anna Ludovica, Anstee, Quentin M. +7 more·2018·Journal of Hepatology
DOI 10.1016/j.jhep.2018.05.019
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Abstract

Background & aims 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 non-alcoholic fatty liver disease (NAFLD), accounting for possible differences in liver stiffness measurement (LSM) values between M and XL probes.Methods We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within six 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 LSM was measured by both M and XL probes (training set) in 314 patients, while only M or XL probe (validation sets) were used to measure LSM in 338 and 138 patients, respectively. In the training set, use of Baveno VI and expanded Baveno VI criteria reduced the number of EGD by 33.3% and by 58%, with 0.9% and 3.8% of large esophageal varices missed, respectively. The best thresholds to rule-out VNT were identified as platelet count >110,000/mm 3 and LSM <30 kPa for M probe, and platelet count >110,000/mm 3 and LSM <25 kPa for XL probe (NAFLD cirrhosis criteria). Thus, usage of NAFLD cirrhosis criteria would have 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 the use of EGD for screening of VNT in NAFLD cirrhosis by more than half, with a chance of missing VNT below 5%.Lay summary In non-alcoholic fatty liver disease-related compensated cirrhosis, the expanded Baveno VI criteria work better than the Baveno VI criteria for ruling out the presence of varices needing treatment, sparing unnecessary and invasive screening procedures. New diagnostic criteria for this patient group, based on liver stiffness measurement and platelet count, and optimized for the specific FibroScan® probe used, work better than both Baveno VI and expanded Baveno VI criteria. The accuracy of all non-invasive scoring criteria was lower in non-obese patients.

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  • The low missed rate for varices needing treatment when LSM is < 20 kPa and platelet count is > 150 × 10^9/L has been confirmed in a multicentre cohort of individuals with MASH-related cirrhosis.

    “This notion has been con fi rmed in a multicentre cohort of individuals with MASH-related cirrhosis. 478”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [478]

    The Statistical analysis section defines the stated LSM and platelet thresholds, and the Training Set and Validation Set sections report low rates of missed varices needing treatment (0.9% and 4.4%, respectively). Patients selection describes a multicentre cohort with NAFLD-related compensated cirrhosis, but it does not establish MASH in all participants; in patients without histology, NAFLD was diagnosed from steatosis and a metabolic-syndrome criterion. (LLM, conf=0.84)

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Authors
Petta, S., Sebastiani, G., Bugianesi, E., Viganò, M., Wong, V. W.-S., Berzigotti, A., Fracanzani, A. L., Anstee, Q. M., Marra, F., Barbara, M., Calvaruso, V., Cammà, C., Di Marco, V., Craxì, A., & de Ledinghen, V.
Affiliations
  • University of Palermo (IT)
  • McGill University Health Centre (CA)
  • University of Turin (IT)
  • University of Milan (IT)
  • Chinese University of Hong Kong (HK)
  • University of Bern (CH)
  • Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
  • University of Florence (IT)
Corresponding author
Petta, Salvatore
ORCID
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2018-10
Volume
69
Issue
4
Pages
878-885
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2018.05.019
OpenAlex
W2804844194
Cited by
140
References
17
Citations by year
2026: 8 · 2025: 7 · 2024: 11 · 2023: 17 · 2022: 17 · 2021: 26 · 2020: 28 · 2019: 21 · 2018: 5
FWCI
12.53
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion)
  • Florence Research (University of Florence) (submittedVersion, other-oa)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
Funders
European Union (634413)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Esophageal Cancer Research and Treatment
Keywords
esophageal varices, compensated cirrhosis, Baveno VI criteria, liver stiffness measurement, FibroScan, platelet count, endoscopy avoidance, non-invasive screening, portal hypertension
MeSH terms
Aged, Cross-Sectional Studies, Esophageal and Gastric Varices, Female, Humans, Liver Cirrhosis, Male, Middle Aged, Platelet Count, Endoscopy, Digestive System, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease

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