Assessing the Relevance of Baveno VI Guidelines for Esophageal Varices in Sub-Saharan Africa: Insights from a Tertiary Health Institution in Nigeria

Abstract

Background: Screening endoscopy has long been regarded as the standard of care for variceal surveillance in patients with chronic liver disease. However, Baveno consensus reports, including the latest Baveno VII, have advocated for the adoption of noninvasive modalities as alternative strategies for surveillance. Nevertheless, their applicability remains constrained in settings lacking access to the latest FibroScan technology. The Baveno VI consensus recommends that patients with a liver stiffness measurement (LSM) <20 kPa and a platelet count >150 × 10 9 /L have a very low risk of having varices requiring treatment and can avoid screening endoscopy. Aim: To validate the Baveno VI criteria among patients with compensated advanced chronic liver disease (cACLD). Methods: In this analytical cross-sectional study, 70 cACLD patients with LSM >10 kPa underwent clinical evaluation, transient elastography, abdominal ultrasound, and biochemical analyses. Upper gastrointestinal endoscopy assessed esophageal varices, graded as high risk varices (HRV) or low risk varices (LRV). Results: Esophageal varices were found in 41.4% (29/70) of patients. Baveno VI criteria showed 43.1% sensitivity and 25.0% negative predictive value (NPV) for absent/LRV, with a 91.7% NPV for varices needing treatment (VNT), effectively ruling out high-risk cases. The criteria spared endoscopy in 37.1% (26/70) of patients, with only one having HRV, yielding a 3.8% VNT miss rate. Conclusion: The Baveno VI consensus is effective for excluding HRV in cACLD patients in our setting, supporting its use for variceal surveillance in sub-Saharan Africa where spleen stiffness measurement (Baveno VII) is unavailable. Further research is needed to establish cost-effective local cutoffs.