Your browser doesn't support javascript.
loading
Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy.
Thabut, Dominique; Bureau, Christophe; Layese, Richard; Bourcier, Valérie; Hammouche, Maryam; Cagnot, Carole; Marcellin, Patrick; Guyader, Dominique; Pol, Stanislas; Larrey, Dominique; De Lédinghen, Victor; Ouzan, Denis; Zoulim, Fabien; Roulot, Dominique; Tran, Albert; Bronowicki, Jean-Pierre; Zarski, Jean-Pierre; Goria, Odile; Calès, Paul; Péron, Jean-Marie; Alric, Laurent; Bourlière, Marc; Mathurin, Philippe; Blanc, Jean-Frédéric; Abergel, Armand; Serfaty, Lawrence; Mallat, Ariane; Grangé, Jean-Didier; Attali, Pierre; Bacq, Yannick; Wartelle-Bladou, Claire; Dao, Thông; Pilette, Christophe; Silvain, Christine; Christidis, Christos; Capron, Dominique; Bernard-Chabert, Brigitte; Hillaire, Sophie; Di Martino, Vincent; Sutton, Angela; Audureau, Etienne; Roudot-Thoraval, Françoise; Nahon, Pierre.
Afiliação
  • Thabut D; Paris Sorbonne Université, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Service d'hépato-gastroentérologie, Paris, France. Electronic address: dominique.thabut@aphp.fr.
  • Bureau C; Service d'hépato-gastroentérologie, Hôpital Purpan CHU Toulouse, 31059 Toulouse Cedex; Université Paul Sabatier Toulouse III, Toulouse.
  • Layese R; AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil.
  • Bourcier V; AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris.
  • Hammouche M; AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris.
  • Cagnot C; ANRS (France Recherche Nord & sud Sida-HIV Hépatites), Paris.
  • Marcellin P; AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy.
  • Guyader D; CHU Pontchaillou, Service d'Hépatologie, Rennes.
  • Pol S; AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris.
  • Larrey D; Hôpital Saint Eloi, Service d'Hépatologie, Montpellier.
  • De Lédinghen V; Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux.
  • Ouzan D; Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var.
  • Zoulim F; Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon.
  • Roulot D; AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny.
  • Tran A; CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice.
  • Bronowicki JP; Hôpital Brabois, Service d'Hépatologie, Vandoeuvre-les-Nancy.
  • Zarski JP; Hôpital Michallon, Service d'Hépatologie, Grenoble.
  • Goria O; Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen.
  • Calès P; CHU d'Angers, Service d'Hépatologie, Angers.
  • Péron JM; Hôpital Purpan, Service d'Hépatologie, Toulouse.
  • Alric L; CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse.
  • Bourlière M; Hôpital Saint Joseph, Service d'Hépatologie, Marseille.
  • Mathurin P; Hôpital Claude Huriez, Service d'Hépatologie, Lille.
  • Blanc JF; Hôpital Haut-Lévêque, CHU Bordeaux, Pessac.
  • Abergel A; Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand.
  • Serfaty L; AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris.
  • Mallat A; AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil.
  • Grangé JD; AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris.
  • Attali P; AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif.
  • Bacq Y; Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours.
  • Wartelle-Bladou C; Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence.
  • Dao T; Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen.
  • Pilette C; CHU Le Mans, Service d'Hépatologie, Le Mans.
  • Silvain C; CHU de Poitiers, Service d'Hépatologie, Poitiers.
  • Christidis C; Institut Mutualiste Montsouris, Service d'Hépatologie, Paris.
  • Capron D; Hôpital Amiens Nord, Service d'Hépatologie, Amiens.
  • Bernard-Chabert B; Hôpital Robert Debré, Service d'Hépatologie, Reims.
  • Hillaire S; Hôpital Foch, Service de médecine interne, Suresnes.
  • Di Martino V; Hôpital Jean Minjoz, Service d'Hépatologie, Besançon.
  • Sutton A; CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny, France.
  • Audureau E; AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil.
  • Roudot-Thoraval F; AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil.
  • Nahon P; AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris.
Gastroenterology ; 156(4): 997-1009.e5, 2019 03.
Article em En | MEDLINE | ID: mdl-30768988
BACKGROUND & AIMS: Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy. METHODS: We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT. RESULTS: A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5-80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival. CONCLUSIONS: In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Varizes Esofágicas e Gástricas / Programas de Rastreamento / Vigilância da População / Guias de Prática Clínica como Assunto / Cirrose Hepática Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Screening_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Gastroenterology Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Varizes Esofágicas e Gástricas / Programas de Rastreamento / Vigilância da População / Guias de Prática Clínica como Assunto / Cirrose Hepática Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Screening_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Gastroenterology Ano de publicação: 2019 Tipo de documento: Article