Non-invasive Prediction of High-risk Varices in Patients with Primary Biliary Cholangitis and Primary Sclerosing Cholangitis.

Moctezuma-Velazquez, Carlos; Saffioti, Francesca; Tasayco-Huaman, Stephanie; Casu, Stefania; Mason, Andrew; Roccarina, Davide; Vargas, Victor; Nilsson, Jan-Erick; Tsochatzis, Emmanuel; Augustin, Salvador; Montano-Loza, Aldo J; Berzigotti, Annalisa; Thorburn, Douglas; Genesca, Joan; Abraldes, Juan Gonzalez (2019). Non-invasive Prediction of High-risk Varices in Patients with Primary Biliary Cholangitis and Primary Sclerosing Cholangitis. The American journal of gastroenterology, 114(3), pp. 446-452. Nature Publishing Group 10.1038/s41395-018-0265-7

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BACKGROUND

Baveno-VI guidelines recommend that patients with compensated cirrhosis with liver stiffness by transient elastography (LSM-TE) <20 kPa and platelets >150,000/mm do not need an esophagogastroduodenoscopy (EGD) to screen for varices, since the risk of having varices needing treatment (VNT) is <5%. It remains uncertain if this tool can be used in patients with cholestatic liver diseases (ChLDs): primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). These patients may have a pre-sinusoidal component of portal hypertension that could affect the performance of this rule. In this study we evaluated the performance of Baveno-VI, expanded Baveno-VI (LSM-TE <25 kPa and platelets >110,000/mm), and other criteria in predicting the absence of VNT.

METHODS

This was a multicenter cross-sectional study in four referral hospitals. We retrospectively analyzed data from 227 patients with compensated advanced chronic liver disease (cACLD) due to PBC (n = 147) and PSC (n = 80) that had paired EGD and LSM-TE. We calculated false negative rate (FNR) and number of saved endoscopies for each prediction rule.

RESULTS

Prevalence of VNT was 13%. Baveno-VI criteria had a 0% FNR in PBC and PSC, saving 39 and 30% of EGDs, respectively. In PBC the other LSM-TE-based criteria resulted in FNRs >5%. In PSC the expanded Baveno criteria had an adequate performance. In both conditions LSM-TE-independent criteria resulted in an acceptable FNR but saved less EGDs.

CONCLUSIONS

Baveno-VI criteria can be applied in patients with cACLD due to ChLDs, which would result in saving 30-40% of EGDs. Expanded criteria in PBC would lead to FNRs >5%.

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