摘要
Acute variceal bleeding is one of the most common and potentially life-threatening complications in patients with liver cirrhosis.It is conventionally diagnosed by oesophagogastroduodenoscopy,which is invasive to patients and carries hospital costs.It would be more cost-effective if non-invasive tests could screen out high-risk patients who developed acute variceal bleeding requiring endoscopic treatment.That can potentially reduce the need for invasive procedures for cirrhotic patients.In recent years,there have been advancements in non-invasive methods for assessing the risk of variceal bleeding.These include transient elastography(FibroScan)of the liver and spleen,platelet count,imaging modalities[ultrasound or magnetic resonance imaging(MRI)],and non-invasive liver function tests[Child-Pugh score or the Model for End-Stage Liver Disease(MELD)score].The 2015 Baveno VI consensus is developed by an international panel of experts to improve the diagnosis and management of portal hypertension and its complications,specifically focusing on variceal bleeding in patients with cirrhosis(1).The consensus emphasizes using noninvasive methods to screen out high-risk varices(HRV)requiring therapeutic endoscopy.The key features of the Baveno VI criteria include a liver stiffness measurement(LSM)<20 kPa and a platelet count>150,000/mm3.It can confidently rule out HRV.It has been proven to avoid unnecessary endoscopy up to 40%with a specificity of up to 46%(2).In recent years,spleen stiffness measurement(SSM)has been a useful tool to assess portal hypertension and to predict HRV.Hence,the revised Baveno VII consensus in 2022 recommends SSM≤40 kPa would avoid more unnecessary endoscopy in patients who fall outside Baveno VI criteria,with a missed HRV rate of<5%(3).
