P2808 - Application of the EVendo Score for Variceal Screening in Patients with Hepatocellular Carcinoma

Punya Chittajallu, MD¹, Jihane N. Benhammou, MD, PhD², Arpan Patel, MD, PhD³, Benjamin Dreskin, MD², James Tabibian, MD, PhD², Tien Dong, MD, PhD^2
1Ronald Reagan UCLA Medical Center, Los Angeles, CA; ²West Los Angeles VA Medical Center, Los Angeles, CA; ³UCLA, Santa Monica, CA

Introduction: Since its development in 2019, the EVendo score successfully predicts the presence of esophageal varices (EVs) and varices needing treatment (VNT) in patients with cirrhosis using non-invasive methods. Aiming to broaden its application, we applied the EVendo score to predict VNT in patients with hepatocellular carcinoma (HCC). Understanding these patients’ risk of EVs and VNT can guide decisions for performing EGD in patients who would like to avoid aggressive measures and those receiving atezolizumab/bevacizumab (associated with an increased risk of bleeding) and prevent delay of treatment initiation.

Methods: 110 male patients with HCC were identified from 9/2004 to 4/2021. We excluded 48 veterans who did not receive an EGD near the time of diagnosis or with a history of prior band ligation. Of the remaining 62 patients, we collected clinical variables at the time of EGD following HCC diagnosis. We included parameters needed to calculate an EVendo score (INR, AST, BUN, hemoglobin, platelet count, and presence of ascites), prognostic scores (Child-Turcotte-Pugh [CTP], MELD-Na), and whether patients were within Milan staging criteria. From endoscopic reports, we assessed presence of EVs, VNT (defined as medium to large EV or with recent stigmata of bleeding), and varices not needing treatment (VNNT), defined as small EV without recent stigmata of bleeding or no EV.

Results: Of the 62 HCC patients analyzed, only 6 did not have cirrhosis, 49 were CTP A, and 7 were CTP B with an average MELD-Na of 11.7 (range 8-21). Fifty-four veterans (87.1%) met Milan criteria. In this cohort, the EVendo score had a sensitivity of 100% and specificity of 54.4% for VNT. The EVendo score predicted all 5 patients that had VNT with a negative predictive value (NPV) of 100%. Thirty-one EGDs (50%) in this cohort could have been deferred if the EVendo score was applied. These results are similar to the results of the EVendo score and Baveno VI criteria in non-HCC CTP A cirrhotic patients undergoing screening EGD for EV.

Discussion: The EVendo score successfully predicted VNTs in a cohort of patients with HCC with 100% NPV. This suggests its potential application to patients undergoing evaluation for initiation of atezolizumab/bevacizumab to forego a screening EGD and prevent treatment delay. Though validation cohorts are needed, its application may successfully reduce unnecessary EGDs.

	VNT	VNNT
EVendo (+)	5 (8.1%)	26 (41.9%)
EVendo (-)	0 (0%)	31 (50%)
Test Parameters
Sensitivity		100%
Specificity		54.4%
Positive Predictive Value		16.2%
Negative Predictive Value		100%

Table: Confusion Matrix for VNT Detected by EVEndo Score
(VNT: varices needing treatment; VNNT: varices not needing treatment)


Disclosures:
Punya Chittajallu indicated no relevant financial relationships.
Jihane Benhammou indicated no relevant financial relationships.
Arpan Patel indicated no relevant financial relationships.
Benjamin Dreskin indicated no relevant financial relationships.
James Tabibian indicated no relevant financial relationships.
Tien Dong indicated no relevant financial relationships.


Punya Chittajallu, MD¹, Jihane N. Benhammou, MD, PhD², Arpan Patel, MD, PhD³, Benjamin Dreskin, MD², James Tabibian, MD, PhD², Tien Dong, MD, PhD². P2808 - Application of the EVendo Score for Variceal Screening in Patients with Hepatocellular Carcinoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.