Egyptian revalidation of non-invasive parameters for predicting esophageal varices in cirrhotic patients: A retrospective study

Background and study aims: In resource-limited countries, non-invasive tests for assessing liver fibrosis are a potential alternative to costly endoscopic screening for esophageal varices. We aimed to validate several non-invasive parameters for predicting the presence of varices.Patients and methods: Between September 2006 and August 2017, a total of 46,014 patients who under-went upper gastrointestinal endoscopy as one of the perquisites for receiving hepatitis C virus (HCV) therapy were enrolled and divided into group I (without varices) and group II (with varices). Non-invasive parameters of fibrosis, namely Lok index, Bonacini score, liver stiffness, FIB-4, Baveno, and extended Baveno criteria, were validated.Results: Lok index, Bonacini score, liver stiffness, and FIB-4 had areas under the receiver operating char-acteristic curve (AUCs) of >0.6 (all P < 0.01 for the null hypothesis that the AUC was 0.5) for determination of the presence/absence of varices, with cutoff values of 0.80, 6.5, 21.9 kPa, and 2.94, and sensitivities of 74%, 74%, 66%, and 83%, respectively. The expanded Baveno VI criteria performed better than the Baveno VI criteria (spared endoscopy rate 81% versus 63%).Conclusion: The use of non-invasive methods is of limited value in predicting esophageal varices. The lim-ited accuracy of <60% may delay the use of appropriate primary prophylaxis against variceal bleeding in a large proportion of cirrhotic patients.(c) 2022 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.