Performance of Baveno VI and Expanded Baveno VI Criteria for Excluding High-risk Varices in Patients with Chronic Liver Diseases: A Systematic Review and Meta-analysis

Abstract Background & Aims We aimed to assess the accuracy of Baveno VI criteria for identification of high-risk varices (HRVs) and varices of any size in patients with compensated advanced chronic liver disease (cACLD). Methods We performed a systematic search of publications through December 2018 for studies that assessed the accuracy of Baveno VI criteria for screening for varices in patients with cACLD. We used hierarchical models to synthesize evidence. We also conducted a post-hoc analysis to assess the accuracy of Expanded Baveno VI criteria. We appraised the confidence in estimates using the GRADE approach. Results We identified 30 studies (8469 participants). Pooled values of Baveno VI criteria for HRVs (26 studies) were sensitivity 0.97 (95%CI, 0.95–0.98) and specificity 0.32 (95%CI, 0.26–0.39). Pooled sensitivity of Expanded Baveno VI criteria for HRVs (12 studies) was 0.90 (95%CI, 0.85–0.93) and specificity was 0.51 (95% CI, 0.45–0.57). In 1000 patients with cACLD, with a prevalence of HRVsof 20%, Baveno VI criteria would prevent endoscopy in 262 patients but 6 patients with HRVs would be missed. Instead, use of the Expanded Baveno VI criteria would resultin 428 patientsavoiding endoscopy, but 20 patients with HRVs would be missed.The credibility of ourfindings is moderate or low, mainly due to the retrospective design of most studies. Conclusions Baveno VI criteria have high diagnostic accuracy as triage test for screening for HRVs in patients with cACLD. ExpandedBaveno VI criteria could further reduce the proportion of unnecessary endoscopies, nevertheless with a higher rate of missed HRVs.