Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy - Université Sorbonne Paris Nord Accéder directement au contenu
Article Dans Une Revue Gastroenterology Année : 2019

Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy

1 CHU Pitié-Salpêtrière [AP-HP]
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 CEpiA - Clinical Epidemiology and Ageing : Geriatrie Soins Primaires et Santé Publique
4 U1162 - Génomique Fonctionnelle des Tumeurs Solides
5 ANRS France Recherche Nord & sud Sida-hiv hépatites
6 Hôpital Beaujon [AP-HP]
7 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
8 Service d'hépatologie médicale [CHU Cochin]
9 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
10 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
11 Hôpital Haut-Lévêque [CHU Bordeaux]
12 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
13 Hôpital Avicenne [AP-HP]
14 C3M - Centre méditerranéen de médecine moléculaire
15 CHU Nice - Centre Hospitalier Universitaire de Nice
16 Hôpital Michallon
17 Hôpital Charles Nicolle [Rouen]
18 CHU Angers - Centre Hospitalier Universitaire d'Angers
19 Hôpital Saint-Joseph [Marseille]
20 Hôpital Claude Huriez [Lille]
21 Service d'Hépatologie Gastro-entérologie [CHU Clermont-Ferrand]
22 CHU Saint-Antoine [AP-HP]
23 INSERM U64 [AP-HP Hôpital Tenon]
24 CHB - Centre Hépato-Biliaire [Hôpital Paul Brousse]
25 Département d'Hépato-Gastroentérologie [Hôpital Trousseau, Tours]
26 CHIAP - Centre Hospitalier d'Aix en Provence [Aix-en-Provence]
27 Hôpital Côte de Nacre [CHU Caen]
28 Centre Hospitalier Le Mans (CH Le Mans)
29 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
30 IMM - Institut Mutualiste de Montsouris
31 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
32 Hôpital Robert Debré Paris
33 Hôpital Foch [Suresnes]
34 Hôpital JeanMinjoz
35 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
Dominique Thabut
  • Fonction : Auteur
  • PersonId : 1099032
Patrick Marcellin
  • Fonction : Auteur
  • PersonId : 900183
Victor de Lédinghen
  • Fonction : Auteur
  • PersonId : 904330
Denis Ouzan
Fabien Zoulim
Dominique Roulot
  • Fonction : Auteur
  • PersonId : 881479
Jean-Pierre Bronowicki
  • Fonction : Auteur
  • PersonId : 900180
Jean-Pierre Zarski
  • Fonction : Auteur
  • PersonId : 916789
Paul Calès
Laurent Alric
  • Fonction : Auteur
  • PersonId : 881462
Marc Bourlière
  • Fonction : Auteur
  • PersonId : 900179
Philippe Mathurin
  • Fonction : Auteur
  • PersonId : 903127
Lawrence Serfaty
Thông Dao
Christos Christidis
Vincent Di Martino
  • Fonction : Auteur
  • PersonId : 914725
Pierre Nahon
  • Fonction : Auteur
  • PersonId : 849826
Anrs Co12 Cirvir Group
  • Fonction : Auteur

Résumé

Background & aims: Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy. Methods: We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT. Results: A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5-80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival. Conclusions: In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.

Dates et versions

hal-03578953 , version 1 (17-02-2022)

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Citer

Dominique Thabut, Christophe Bureau, Richard Layese, Valérie Bourcier, Maryam Hammouche, et al.. Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy. Gastroenterology, 2019, 156 (4), pp.997-1009.e5. ⟨10.1053/j.gastro.2018.11.053⟩. ⟨hal-03578953⟩
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