Screening
Check your local protocols for recommendations on screening.
The UK National Institute for Health and Care Excellence (NICE) recommends upper gastrointestinal (GI) endoscopy to detect oesophageal varices in all patients after a diagnosis of cirrhosis.[17]
NICE recommends surveillance using upper GI endoscopy every 3 years for patients with no varices detected on endoscopy.[17]
The British Gastroenterology Society recommends endoscopy at 2- to 3-year intervals for these patients. [5]
In practice, many hospitals in the UK use the expanded-Baveno VII criteria to identify patients with a low probability of having high-risk gastro-oesophageal varices in whom screening endoscopy can be avoided.
Patients with a liver stiffness measurement (LSM) <20 kPa and a platelet count >150,000/mm³ have a very low probability (<5%) of having high-risk varices; therefore, endoscopy can be safely avoided.[6]
Patients who do not satisfy these criteria should undergo screening endoscopy when the diagnosis of cirrhosis is made.
Expanded-Baveno VI criteria have been validated in several patient cohorts (with compensated advanced chronic liver disease) and suggest that endoscopy may only be indicated if LSM ≥25 kPa and platelet count ≤110 x 10⁹ cells/L.[52] This prediction rule would potentially avoid 40% of endoscopies, with an associated risk of missing 0.6% (95% CI 0.3 to 1.4%) of varices requiring treatment among patients with compensated advanced chronic liver disease.[52]
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