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

Puigvehí, Mark ; Londoño, María Carlota ; Torras, Xavier ; Lorente, Sara (Universidad de Zaragoza) ; Vergara, Mercedes ; Morillas, Rosa María ; Masnou, Helena ; Serrano, Trinidad (Universidad de Zaragoza) ; Miquel, Mireia ; Gallego, Adolfo ; Lens, Sabela ; Carrión, José Antonio

Resumen: Background Direct-acting antivirals (DAAs) show highefficacy and safety in HCV–cirrhotic patients, but mostmaintain clinically significant portal hypertension aftersustainedvirologicalresponse(SVR).Non-invasiveBaveno and expanded-Baveno criteria can identifypatients without high-risk gastroesophageal varices (GEV)who have no need for endoscopic surveillance. However,data after SVR are scarce. We performed a multicenterstudy to evaluate SVR effects over GEV and diagnosticaccuracy of non-invasive criteria after SVR.
Methods HCV–cirrhotic patients receiving DAAs andbaseline endoscopic evaluation were included (November2014–October 2015). GEV were classified as low risk (LR-GEV) (\5 mm) or high risk (HR-GEV) (C5 mm or withrisk signs). Transient elastography (TE) and endoscopywere performed during follow-up.
Results SVR was achieved in 230 (93.1%) of 247included 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 TEC25 kPabefore treatment (64.7%) orC20 kPa after SVR (66.7%).Only 6% of patients without GEV and LSM\25 kPabefore treatment, and 10% of those with baseline LSM\25 kPa and LSM\20 kPa after SVR showed GEVprogression after 36 months. The negative predictive valueof 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 recommendedin those with GEV before antiviral treatment. Baveno andexpanded-Baveno criteria can be safely applied after SVR.

Idioma: Inglés

DOI: 10.1007/s00535-019-01619-0

Año: 2020

Publicado en: JOURNAL OF GASTROENTEROLOGY 55, 2 (2020), 205-216
ISSN: 0944-1174

Factor impacto JCR: 7.527 (2020)

Categ. JCR: GASTROENTEROLOGY & HEPATOLOGY rank: 17 / 92 = 0.185 (2020) - Q1 - T1

Factor impacto SCIMAGO: 2.33 - Gastroenterology (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)