Impact of sustained virological response with DAAs on gastroesophageal varices and Baveno criteria in HCV–cirrhotic patients

Marc Puigvehí, María Carlota Londoño, Xavier Torras, Sara Lorente, Mercedes Vergara, Rosa Maria Morillas, Helena Masnou, Trinidad Serrano, Mireia Miquel, Adolfo Gallego, Sabela Lens, Jose Antonio Carrión

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3 Citations (Scopus)

Abstract

© 2019, Japanese Society of Gastroenterology. Background: Direct-acting antivirals (DAAs) show high efficacy and safety in HCV–cirrhotic patients, but most maintain clinically significant portal hypertension after sustained virological response (SVR). Non-invasive Baveno and expanded-Baveno criteria can identify patients without high-risk gastroesophageal varices (GEV) who have no need for endoscopic surveillance. However, data after SVR are scarce. We performed a multicenter study to evaluate SVR effects over GEV and diagnostic accuracy of non-invasive criteria after SVR. Methods: HCV–cirrhotic patients receiving DAAs and baseline endoscopic evaluation were included (November 2014–October 2015). GEV were classified as low risk (LR-GEV) (< 5 mm) or high risk (HR-GEV) (≥ 5 mm or with risk signs). Transient elastography (TE) and endoscopy were performed during follow-up. Results: SVR was achieved in 230 (93.1%) of 247 included patients, 151 (65.7%) with endoscopic follow-up. Among 64/151 (42.4%) patients without baseline GEV, 8 (12.5%) developed GEV after SVR. Among 50/151 (33.1%) with baseline LR-GEV, 12 (24%) developed HR-GEV. Patients with GEV progression showed TE ≥ 25 kPa before treatment (64.7%) or ≥ 20 kPa after SVR (66.7%). Only 6% of patients without GEV and LSM < 25 kPa before treatment, and 10% of those with baseline LSM < 25 kPa and LSM < 20 kPa after SVR showed GEV progression after 36 months. The negative predictive value of Baveno and expanded-Baveno criteria to exclude HR-GEV was maintained after SVR (100% and 90.7%, respectively). Conclusions: HCV–cirrhotic patients can develop HR-GEV after SVR. Surveillance is especially recommended in those with GEV before antiviral treatment. Baveno and expanded-Baveno criteria can be safely applied after SVR. https://clinicaltrials.gov: NCT02758509.
Original languageEnglish
JournalJournal of Gastroenterology
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • Baveno
  • Cirrhosis
  • Hepatitis C
  • Sustained virological response
  • Varices

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