Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension

2015 Journal of Hepatology 63, 3 (743-752)

"Screening and surveillance: Invasive and non-invasive methods (changed from Baveno III-V) Definition of compensated advanced chronic liver disease (new)
- The introduction of transient elastography (TE) in clinical practice has allowed the early identification of patients with chronic liver disease (CLD) at risk of developing clinically significant portal hypertension (CSPH) (1b;A).
Criteria to suspect cACLD (new)
- Liver stiffness by TE is sufficient to suspect cACLD in asymptomatic subjects with known causes of CLD (1b;A).
- TE often has false positive results; hence two measurements on different days are recommended in fasting conditions (5;D).
- TE values 15 kPa are highly suggestive of cACLD (1b;A). Diagnosis of CSPH in patients with cACLD (new) - In patients with virus related cACLD non-invasive methods are sufficient to rule-in CSPH, defining the group of patients at risk of having endoscopic signs of PH.
The following can be used (2b;B):
- Liver stiffness by TE (P20-25 kPa; at least two measurements on different days in fasting condition; caution should be paid to flares of ALT; refer to EASL guidelines for correct interpretation criteria), alone or combined to platelets and spleen size.
- The diagnostic value of TE for CSPH in other aetiologies remains to be ascertained (5;D). Identification of patients with cACLD who can safely avoid screening endoscopy (new)
- Patients with a liver stiffness 150,000 have a very low risk of having varices requiring treatment, and can avoid screening endoscopy (1b;A).
- These patients can be followed up by yearly repetition of TE and platelet count (5;D).
- If liver stiffness increases or platelet count declines, these patients should undergo screening esophagogastroduodenoscopy (5;D). Extrahepatic portal vein obstruction (EHPVO) Diagnosis (changed from Baveno V)
- Liver biopsy and HVPG are recommended, if the liver is dysmorphic on imaging or liver tests are persistently abnormal, to rule out cirrhosis or idiopathic non-cirrhotic portal hypertension (1b;B). Liver stiffness by TE may be useful to exclude cirrhosis (5;D)."

Pubmed: 26047908