A strategy for varices screening based on acoustic radiation force impulse combined with platelet (CHESS2001): An alternative of Baveno VI criteria. Issue 11 (19th September 2022)

• Record Type: Journal Article
• Authors: Huang, Yifei; Zhao, Lili; He, Ruiling; Li, Shuang; Liu, Chuan; Qi, Xiaolong; Li, Jia
• Is Part Of: Hepatology communications. Volume 6:Issue 11(2022)
• Page Start: 3154
• Page End: 3162
• Publication Date: 2022-09-19
• Subjects: Hepatology -- Periodicals; Liver -- Diseases -- Periodicals; Liver Diseases; Gastroenterology; Periodicals; Fulltext; Internet Resources; Periodicals; 616.36
• DOI: 10.1002/hep4.2076
• Languages: English
• ISSNs: 2471-254X

Abstract

Abstract: Few studies have reported on acoustic radiation force impulse (ARFI) for varices screening. Our study aimed to identify a strategy based on liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) by ARFI combined with platelet count (PLT), named the ARP strategy, for ruling out high‐risk varices (HRV) and avoiding unnecessary esophagogastroduodenoscopy (EGD) in patients with compensated cirrhosis. We retrospectively reviewed patients who underwent ARFI from a previous cohort (NCT04307264). Of them, patients between 2017 and 2019 composed the training cohort to develop the ARP strategy. The validation cohort consisted of others between 2015 and 2016 to validate and compare it with Baveno VI criteria about the performance for varices screening. Primary outcomes were the rates of spared EGDs and HRV missed. A total of 741 consecutive patients were included in the final analysis. Of them, 576 patients were included in the training cohort and 165 patients in the validation cohort. In the training cohort, ARP strategy was defined as LSM < 1.805 m/s or SSM < 2.445 m/s and PLT > 110 × 10 9 /L. ARP strategy could spare 234 (40.6%) EGDs with a missed HRV rate of 3.4% (8 of 234). In the validation cohort, compared with Baveno VI criteria, the ARP strategy improved the proportion of avoided EGDs (49.7% vs. 34.5%; p < 0.001) and lowered the rate of misclassified HRV (1.2% vs. 3.5%; p < 0.001). Conclusion : The ARP strategy was an efficient and safe tool for varices screening in compensated cirrhosis, and it might be an auxiliary or even alternative to Baveno VI criteria. Abstract : The recent Baveno VII guideline recommended the validation of LSM thresholds for HRV obtained from devices other than TE to improve the performance for varices screening. Our study developed and validated a novel varices screening strategy, ARP strategy, based on LSM and SSM by ARFI combined with PLT to rule out HRV in patients with compensated cirrhosis. The data indicated that ARP strategy was an efficient and safe model for avoiding unnecessary EGD, and it might be an auxiliary or even alternative tool of Baveno VI.image