| AimThe current gold standard for diagnosing esophageal and gastric varices in patients with liver cirrhosis is esophagogastroduodenoscopy(EGD).However,the high cost and pain of EGD cannot be accepted by patients,so it is of great importance to explore a non-invasive method suitable for Chinese patients with cirrhosis.Therefore,the purpose of this study is:under the etiology of cirrhosis in China,(1)To validate the efficacy of Baveno ? and expanded Baveno ? criteria for HBV-related cirrhosis;(2)To evaluate the effect of spleen stiffness in predicting esophageal varices in patients with cirrhosis;(3)To explore a new predictive model to evaluate its efficacy as a non-invasive alternative to EGD in the screening of varices in cirrhosis.MethodConsecutive patients with cirrhosis who were willing to participate in our trial were prospectively enrolled from April 2019 to February 2020 at the hepatology unit of the Nanfang Hospital,China.All patients underwent liver and spleen transient elastography(TE)and EGD at enrollment.Baseline data,antiviral therapy,laboratory indicators and imaging examinations were collected.The efficacy of non-invasive methods and EGD in predicting high risk varices was statistically compared.ResultDuring the study period from April 2019 to February 2020,we prospectively recruited patients who attended the Liver Disease Center of Nanfang Hospital,and a total of 660 patients with liver cirrhosis caused by various etiologies were screened.According to the criteria for inclusion and exclusion of viral cirrhosis,220 patients were excluded,and 440 patients with viral cirrhosis who were undergoing antiviral therapy were finally included in the analysis.The prevalence of high risk varice(HRV)was 22.7%.The Baveno VI criteria safely rule out HRV in cirrhosis patients treated with antiviral therapy,and 31.8%of patients were spared EGD screening.Spleen stiffness measurement(SSM?46.0 kPa)is proven to safely exclude HRV(HRV missed rate is 4.3%),and 53.9%of patients with liver cirrhosis can be spared from EGD examination.The combined model(Baveno VI standard combination SSM?46 kPa)could exempt 58.4%of patients with cirrhosis from gastroscopy,and the rate of HRV missed diagnosis was 5%.A total of 319 patients with viral suppressed cirrhosis were excluded,and 341 HBV-related cirrhosis with viral suppressed were eventually included in the analysis,of whom 70 patients(20.5%)had HRV.The application of Baveno VI criteria to exclude HRV can save 37%of patients from EGD and not miss any HRV.When SSM?46 kPa was used to rule out HRV and 52.8%of patients were spared from EDG,the missed diagnosis rate was only 4.3%.The combined model(Baveno VI standard combination SSM?46kPa)can safely rule out HRV in patients with viral suppressed liver cirrhosis,and the EGD spared rate is 61.6%.ConclusionIn a cohort of viral cirrhosis treated with long-term antiviral therapy and a cohort of viral suppressed cirrhosis,we demonstrated that the Baveno VI criteria alone and SSM?46 kPa could safely rule out patients with HRV.We further explored the excellent performance of the combination model of Baveno VI criteria combined with SSM in ruling out HRV,and found that the combination model could avoid EGD examination in more than half of the patients with cirrhosis(61.6%).This simple algorithm(Baveno VI/SSM ?46 kPa)can be used as a convenient and effective non-invasive HRV screening method to guide future monitoring strategies. |
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