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Cited by 2,930Liver Disease and TransplantationLiver Disease Diagnosis and TreatmentLiver Diseases and Immunity

Baveno VII – Renewing consensus in portal hypertension

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de Franchis, Roberto, Bosch, Jaime, Garcia-Tsao, Guadalupe, Reiberger, Thomas, Ripoll, Cristina, Abraldes, Juan G., Albillos, Agustin, Baiges, Anna +58 more·2022·Journal of Hepatology
DOI 10.1016/j.jhep.2021.12.022PMC PMC11090185
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Abstract

To expand on the work of previous meetings, a virtual Baveno VII workshop was organised for October 2021. Among patients with compensated cirrhosis or compensated advanced chronic liver disease (cACLD - defined at the Baveno VI conference), the presence or absence of clinically significant portal hypertension (CSPH) is associated with differing outcomes, including risk of death, and different diagnostic and therapeutic needs. Accordingly, the Baveno VII workshop was entitled "Personalized Care for Portal Hypertension". The main fields of discussion were the relevance and indications for measuring the hepatic venous pressure gradient as a gold standard, the use of non-invasive tools for the diagnosis of cACLD and CSPH, the impact of aetiological and non-aetiological therapies on the course of cirrhosis, the prevention of the first episode of decompensation, the management of an acute bleeding episode, the prevention of further decompensation, as well as the diagnosis and management of splanchnic vein thrombosis and other vascular disorders of the liver. For each of these 9 topics, a thorough review of the medical literature was performed, and a series of consensus statements/recommendations were discussed and agreed upon. A summary of the most important conclusions/recommendations derived from the workshop is reported here. The statements are classified as unchanged, changed, and new in relation to Baveno VI.

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Crossref · 10.1016/j.jhep.2021.12.022

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  • NSBBs and endoscopic variceal ligation are both acceptable treatments for primary prophylaxis against the first episode of variceal haemorrhage.

    “NSBBs and endoscopic variceal ligation are both acceptable treatments for primary prophylaxis against the fi rst episode of variceal haemorrhage. 473”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [473]

    In ‘Prevention of (first) decompensation’ (recommendations 5.14 and 5.19; page not provided), Baveno VII supports NSBB use and recommends band ligation to prevent first variceal bleeding. But it recommends ligation specifically for compensated patients with high-risk varices who cannot tolerate NSBBs or have contraindications; the claim omits that restriction and presents the treatments as generally interchangeable. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The LSM cutoff of 25 kPa has been used to rule in CSPH in individuals with various liver diseases such as chronic viral hepatitis and MASLD.

    “The LSM cutoff of 25 kPa has been used to rule in CSPH in individuals with various liver diseases such as chronic viral hepatitis and MASLD. 473”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [473]

    In “Diagnosis of CSPH in patients with cACLD” (statement 2.16; page not provided), Baveno VII says LSM by transient elastography ≥25 kPa can rule in CSPH for virus- or alcohol-related cACLD and non-obese NASH-related cACLD. The claim omits the cACLD and non-obesity restrictions and broadens NASH-related disease to MASLD generally. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • VCTE values >10 kPa are suggestive, while values >15 kPa are highly suggestive of ACLD.

    “Usually, VCTE is widely available and values of >10 kPa are suggestive, while values >15 kPa are highly suggestive of ACLD [71, 72].”

    From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [72]

  • In patients with non-obese NASH ACLD, a VCTE value ≥25 kPa is sufficient to rule in CSPH.

    “Higher values further increase the accuracy for non‐invasively predicting clinically significant portal hypertension (CSPH), whereas in patients with non‐obese NASH ACLD a VCTE value ≥25 kPa is sufficient to rule in CSPH [72].”

    From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [72]

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Research works printed but not linked: 7

  1. [1]Burroughs AK, editor. Methodology and review of clinical trials in portal hypertension. Amsterdam, New York, Oxford: Excerpta Medical Congress Service N◦ 763; 1987.
  2. [4]de Franchis R, editor. Portal Hypertension II. Proceedings of the second Baveno international consensus workshop on definitions, methodology and therapeutic strategies. Oxford: Blackwell Science; 1996.
  3. [8]de Franchis R, editor. Portal Hypertension III. Proceedings of the IIIrd Baveno International Consensus Workshop on Definitions, Methodology and Therapeutic Strategies. Oxford, UK: Blackwell Science; 2001.
  4. [10]de Franchis R, editor. Portal Hypertension IV. Proceedings of the IVth Baveno international consensus workshop on methodology of diagnosis and treatment. Oxford, UK: Blackwell publishing; 2006.
  5. [13]de Franchis R, editor. Portal Hypertension V. Proceedings of the Vth Baveno international consensus workshop. Oxford, UK: Wiley-Blackwell; 2011.
  6. [15]de Franchis R, editor. Portal Hypertension VI. Proceedings of the VIth Baveno consensus workshop: stratifying risk and individualizing care. New York, USA: Springer; 2016.
  7. [17]de Franchis R, editor. Portal Hypertension VII. Proceedings of the VIIth Baveno consensus workshop: Personalized care in portal hypertension. New York, USA: Springer; 2022.

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Authors
de Franchis, R., Bosch, J., Garcia-Tsao, G., Reiberger, T., Ripoll, C., Abraldes, J. G., Albillos, A., Baiges, A., Bajaj, J., Bañares, R., Barrufet, M., Benajiba, L., Berzigotti, A., Bureau, C., Calvaruso, V., Cardenas, A., D’Amico, G., De Gottardi, A., Dell’Era, A., Escorsell, A., Fallowfield, J., Ferral, H., Francque, S., Gaba, R., Garcia-Pagàn, J. C., Genescà, J., Rodrigues, S. G., Gracia-Sancho, J., Han, G., Hernandez-Gea, V., Jia, J., Kiladjian, J. J., Krag, A., Laleman, W., La Mura, V., Lens, S., Luo, X., Mandorfer, M., Murad, S. D., Paradis, V., Patch, D., Piano, S., Pinzani, M., Plessier, A., Primignani, M., Procopet, B., Rautou, P. E., Rudler, M., Sarin, S. K., Schepis, F., Senzolo, M., Shah, V., Shukla, A., Tandon, P., Tellez, L., Thabut, D., Thiele, M., Trebicka, J., Tripathi, D., Tsochatzis, E., Turco, L., Turon, F., Valla, D., Villanueva, C., Wanless, I., & Yoshiji, H.
Affiliations
  • University of Bern (CH)
  • Medical University of Vienna (AT)
  • Jena University Hospital (DE)
ORCID
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2022-04
Volume
76
Issue
4
Pages
959-974
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2021.12.022
PMC
PMC11090185
OpenAlex
W4200473175
Cited by
2,930
References
12
Citations by year
2026: 673 · 2025: 697 · 2024: 698 · 2023: 594 · 2022: 266 · 2017: 1
FWCI
216.64
Type
journal article
Language
en
Update notices
erratum (2022-07-01)
Open access
Licence
Locations
  • Journal of Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, other-oa)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
  • PubMed Central (acceptedVersion)
  • HAL (submittedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
  • UCL Discovery (University College London) (submittedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion, cc-by-nc-nd)
Funders
  • American Association for the Study of Liver Diseases
  • Gilead Sciences
  • Asociación Española para el Estudio del Hígado
  • Atsumi International Scholarship Foundation
  • Association Française pour l'Etude du Foie
  • European Association for the Study of the Liver
  • Österreichische Gesellschaft für Gastroenterologie und Hepatologie
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK034989)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords
portal hypertension, compensated cirrhosis, advanced chronic liver disease, hepatic venous pressure gradient, non-invasive diagnosis, variceal bleeding, splanchnic vein thrombosis
MeSH terms
Esophageal and Gastric Varices, Humans, Hypertension, Portal, Liver Cirrhosis, Portal Pressure, Elasticity Imaging Techniques

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