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Thématique :
- Foie (hors cancers)
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/12  
 
  2017 Dec;66(6):1980-1988.  
  doi: 10.1002/hep.29363  
 
  Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease.  
 
  Augustin S, Pons M, Maurice JB, Bureau C, Stefanescu H, Ney M, Blasco H, Procopet B, Tsochatzis E, Westbrook RH, Bosch J, Berzigotti A, Abraldes JG, Genescà J  
  https://www.ncbi.nlm.nih.gov/pubmed/28696510  
 
 

Abstract

Patients with compensated advanced chronic liver disease (cACLD) can safely avoid screening endoscopy with a platelet count >150 × 109cells/L and a liver stiffness measurement (LSM) <20 kPa (Baveno VI criteria). However, the total number of avoided endoscopies using this rule is relatively low. We aimed at expanding the Baveno VI criteria and validating them in additional cohorts. Patients from the Anticipate cohort (499 patients with cACLD of different etiologies) were used to study the performance of different thresholds of platelets and LSM for the identification of patients at very low risk (<5%) of having varices needing treatment (VNT). The new criteria (Expanded-Baveno VI) were validated in two additional cohorts from London (309 patients) and Barcelona (117 patients). The performance of the new criteria by etiology of cACLD was also assessed. The best new expanded classification rule was platelet count >110 × 109 cells/L and LSM <25 kPa. This was validated in the two additional cohorts. Overall, the Expanded-Baveno VI criteria would potentially spare 367 (40%) endoscopies (21% with Baveno VI criteria) with a risk of missing VNT of 1.6% (95% confidence interval, 0.7%-3.5%) in patients within the criteria and 0.6% (95% confidence interval, 0.3%-1.4%) in the overall population of 925 patients evaluated. The Expanded-Baveno VI criteria performed well in patients with cACLD with hepatitis C virus and alcoholic and nonalcoholic steatohepatitis.

CONCLUSION:

The new Expanded-Baveno VI criteria spare more endoscopies than the original criteria with a minimal risk of missing VNT in most of the main etiologies of cACLD. (Hepatology 2017;66:1980-1988).

 

 
Question posée
 
Etendre les critères de Baveno VI sur les seuils limites de plaquettes et d'élasticité hépatique mesurée par Fibroscan et les valider dans 2 autres cohortes (Londres, Barcelone).
 
Question posée
 
Le seuil de plaquettes retenu est de 110000 et d'élasticité <25 kPa. Bonne performance pour les hépatopathies chroniques VHC et alcool permettant d'économiser 40% d'endoscopies pour la recherche de VO nécessitant une prophylaxie primaire.
 
Commentaires

Attention chez les patients alcooliques plus à risque de cancer oesophagien !

 
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