Patients with compensated advanced chronic liver disease (cACLD) can safely avoid screening endoscopy with a platelet count >150 × 10⁹ cells/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)

中文翻译：

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扩展Baveno VI标准以筛查代偿性晚期慢性肝病患者的静脉曲张

患有晚期慢性肝病（cACLD）的患者可以安全地避免筛查内镜，血小板计数> 150×10 ⁹细胞/ L和肝硬度测量值（LSM）<20 kPa（Baveno VI标准）。但是，使用此规则避免的内窥镜检查的总数相对较低。我们旨在扩展Baveno VI标准，并在其他同类群组中对其进行验证。来自“预期”队列的患者（499名不同病因的cACLD患者）用于研究血小板和LSM的不同阈值的表现，以鉴定需要治疗静脉曲张（VNT）的极低风险（<5％）的患者。新标准（Expanded-Baveno VI）在伦敦（309名患者）和巴塞罗那（117名患者）的另外两个队列中得到了验证。还通过cACLD的病因对新标准的执行情况进行了评估。最好的新扩展分类规则是血小板计数> 110×10 ⁹电池/ L和LSM <25 kPa。这在另外两个队列中得到了验证。总体而言，扩展的Baveno VI标准可能会避免367（40％）内镜检查（Baveno VI标准为21％）的风险，在该患者中VNT缺失1.6％（95％置信区间，0.7％-3.5％）的风险。标准和评估的925例患者总数中的0.6％（95％置信区间，0.3％-1.4％）。在患有丙型肝炎病毒，酒精性和非酒精性脂肪性肝炎的cACLD患者中，扩展的Baveno VI标准表现良好。结论：在大多数cACLD的主要病因中，新的Expanded-Baveno VI标准比原标准具有更多的内窥镜检查功能，而遗漏VNT的风险最小。（《肝病学》 2017年； 66：1980–1988年）