P2842 - Are We Missing Varices by Implementing Baveno-VI Recommendation of Not Doing Screening Gastroscopies in Patients With Compensated Advance Chronic Liver Disease?

Faiza S. Ali, MBBS, FCPS, MRCP¹, Bader F. Zuberi, MBBS, FCPS¹, Nimrah Bader, MBBS^2
1Dow University of Health Sciences, Karachi, Sindh, Pakistan; ²University of Oklahoma Health Sciences Center, Oklahoma City, OK

Introduction: Baveno-VI recommended against variceal screening gastroscopies in Compensated Advance Chronic Liver Disease (cACLD). Baveno VI criteria utilized non- invasive markers of avoiding screening gastroscopies in cACLD, who have liver stiffness measurement (LSM) of < 20kPa as measured by liver elastography (LE) and platelet count of > 150 × 10⁹ cells/L, as these patients do not have significant number of varices needing treatment (VNT). We critically analyze this recommendation in our setup by looking at the missing VNT, if following Baveno VI recommendation.

Methods: Prospective cross-sectional study was conducted on cACLD patients from September 2019 till April 2021. Patients segregated into 2 groups. Group-A, having Liver stiffness measurement (LSM) of ≥ 20 kPa and platelet of ≤ 150 × 10⁹ cells/L; and Group-B having LSM of < 20 kPa and PLT of > 150 × 10⁹ cells/L. Gastroscopic findings were segregated into 3 categories, VNT, Varices Not Needing Treatment (VNNT) and No Varix (NV). To generate 2x2 table VNNT and NV were merged. ROC plots were generated for LSM and Platelet for VNT for sensitivity, specificity, NPV and PPV.

Results: A total of 134 patients of cACLD were included Group-A had 72 (53.7%) patients and Group-B had 62 (46.3%) patients. Group-A had 6 (8.3%) NV; 18 (25.0%) VNNT and 48 (66.7%) VNT. Group-B had 26 (41.9%) NV, 24 (38.7%) VNNT and 12 (19.4%) VNT. The sensitivity of 66.7%, specificity of 80.6% and NPV of 67.56% was obtained. Thus 19.4% VNT would have missed if following Baveno recommendations. ROC in our study suggested cutoff value of 11.5 kPa of LSM, having sensitivity of 100% and 1-specifity of 78% (Fig. 1), below which screening gastroscopy can be avoided. Cut off value of platelet count for avoiding screening OGD was ≥ 97.5 × 10⁹ cells/L with a sensitivity of 100 % and 1-specificity of 83.3% as plotted by ROC curve.

Discussion: Substantial number of VNT in cACLD patients are missed by strictly following Baveno VI recommendations in our setup. Cut off value for avoiding screening OGD found to be ≤ 11.5 kPa, representing early cirrhosis in our setup. we recommend that all patients with cirrhosis, who do not have any contraindication, willing to be screened and with easy availability of EGD, should be screened.


Figure: Figure 1: ROC curve of Liver Stiffness Measurement with varix needing treatment

Groups	Age (years)	Platelet Count	LSM (kPa)	Variceal Classification
	Mean	Mean	Mean	NV	VNNT	VNY
				n (%)	n (%)	n (%)
Group-A (n =72)	37.08	112.71	31.49	6 (8.3)	18 (25.0)	48 (66.7)
Group-B (n = 62)	36.06	173.55	13.39	26 (41.9)	24 (38.7)	12 (19.4)

Table: Age, platelets, Liver Stiffness Measurement (LSM) & Variceal Classification according to Groups


Disclosures:
Faiza Ali indicated no relevant financial relationships.
Bader Zuberi indicated no relevant financial relationships.
Nimrah Bader indicated no relevant financial relationships.


Faiza S. Ali, MBBS, FCPS, MRCP¹, Bader F. Zuberi, MBBS, FCPS¹, Nimrah Bader, MBBS². P2842 - Are We Missing Varices by Implementing Baveno-VI Recommendation of Not Doing Screening Gastroscopies in Patients With Compensated Advance Chronic Liver Disease?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.