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Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis
Open accessAbstract
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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“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]
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Cites
Design and validation of a histological scoring system for nonalcoholic fatty liver disease†
Kleiner, D. E., Brunt, E. M., Van Natta, M., Behling, C., Contos, M. J., Cummings, O. W., Ferrell, L. D., Liu, Y., Torbenson, M. S., Unalp‐Arida, A., et al. (2005) · Hepatology · doi:10.1002/hep.20701 · Cited by 10,791
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Expanding consensus in portal hypertension
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Wong, V. W.-S., Vergniol, J., Wong, G. L.-H., Foucher, J., Chan, H. L.-Y., Le Bail, B., Choi, P. C.-L., Kowo, M., Chan, A. W.-H., Merrouche, W., et al. (2010) · Hepatology · doi:10.1002/hep.23312 · Cited by 1,322
Determination of reliability criteria for liver stiffness evaluation by transient elastography
Boursier, J., Zarski, J.-P., de Ledinghen, V., Rousselet, M.-C., Sturm, N., Lebail, B., Fouchard-Hubert, I., Gallois, Y., Oberti, F., Bertrais, S., et al. (2013) · Hepatology · doi:10.1002/hep.25993 · Cited by 662
Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team
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“chronic liver disease and cirrhosis [1], an increasing risk factor for hepatocellular carcinoma [2], and the emerging indication for liver transplantation [3].”
Liver Stiffness Measurement Using XL Probe in Patients With Nonalcoholic Fatty Liver Disease
Wong, V. W.-S., Vergniol, J., Wong, G. L.-H., Foucher, J., Chan, A. W.-H., Chermak, F., Choi, P. C.-L., Merrouche, W., Chu, S. H.-T., Pesque, S., et al. (2012) · American Journal of Gastroenterology · doi:10.1038/ajg.2012.331 · Cited by 345
Self-citationAugustín, S., Pons, M., Maurice, J. B., Bureau, C., Ştefănescu, H., Ney, M., Blasco, H., Procopeț, B., Tsochatzis, E. A., Westbrook, R., et al. (2017) · Hepatology · doi:10.1002/hep.29363 · Cited by 271
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Non-alcoholic fatty liver disease
Powell, E. E., Wong, V. W.-S., & Rinella, M. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32511-3 · Cited by 2,789
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210
Berzigotti, A., Tsochatzis, E., Boursier, J., Castera, L., Cazzagon, N., Friedrich-Rust, M., Petta, S., & Thiele, M. (2021) · Journal of Hepatology · doi:10.1016/j.jhep.2021.05.025 · Cited by 1,925
Ginès, P., Krag, A., Abraldes, J. G., Solà, E., Fabrellas, N., & Kamath, P. S. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01374-x · Cited by 1,663
(2024) · Obesity Facts · doi:10.1159/000539371 · Cited by 545
Metadata
- 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)
- 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
- green
- hdl.handle.net
- 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 › Hepatology › 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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