CHESS Criteria for Varices Screening in Compensated Advanced Chronic Liver Disease (CHESS2001/APPHA2001)
Condition: Compensated Advanced Chronic Liver Disease; Varices Needing Treatment
MeSH terms: Liver Diseases; Varicose Veins
Study type: Observational

Summary: 
      Variceal hemorrhage is the serious complication in patients with compensated advanced chronic
      liver disease (cACLD). To evaluate the bleeding risk of varices in cACLD,
      esophagogastroduodenoscopy (EGD) should be performed. Once identified with medium-large
      varices, or small varices with red signs or Child-Pugh C class, defined as varices needing
      treatment (VNT), the patients with cACLD are recommended to receive the non-selective beta
      blockers or endoscopic variceal ligation per Baveno VI consensus. However, EGD is limited by
      its invasiveness and uncomfortableness. The Baveno VI criteria, which was validated by 310
      patients dominant with hepatitis C virus (55.0%), recommended that EGD could be spared in
      patients with liver stiffness (LS) < 20kPa and platelet count > 150×10^9 cells/L.
      Furthermore, the expanded-Baveno VI criteria (LS < 25kPa and platelet count > 110×10^9
      cells/L), based on European cohort with hepatitis C virus (62.8%), was able to spare more
      unnecessary endoscopies than the Baveno VI criteria with VNT missed rate < 5%. Nevertheless,
      a recent Asian-pacific study indicated that though Baveno VI criteria was able to avoid
      screening endoscopy with 27.6%, it increased the odds of missing VNT in hepatitis B
      virus-related cACLD. Notably, this study also suggested that the expanded-Baveno VI criteria
      was not suited for Asian-pacific cohort with hepatitis B virus as the dominant cause with VNT
      missed rate > 5%. Our study aims to develop and validate an optimal cutoff value of LS and
      platelet count (CHESS criteria) to safely avoid more unnecessary endoscopies in patients with
      hepatitis B virus-dominated cACLD.
    

Detailed description: 
      Variceal hemorrhage is the serious complication in patients with compensated advanced chronic
      liver disease (cACLD). To evaluate the bleeding risk of varices in cACLD,
      esophagogastroduodenoscopy (EGD) should be performed. Once identified with medium-large
      varices, or small varices with red signs or Child-Pugh C class, defined as varices needing
      treatment (VNT), the patients with cACLD are recommended to receive the non-selective beta
      blockers or endoscopic variceal ligation per Baveno VI consensus. However, EGD is limited by
      its invasiveness and uncomfortableness. The Baveno VI criteria, which was validated by 310
      patients dominant with hepatitis C virus (55.0%), recommended that EGD could be spared in
      patients with liver stiffness (LS) < 20kPa and platelet count > 150×10^9 cells/L.
      Furthermore, the expanded-Baveno VI criteria (LS < 25kPa and platelet count > 110×10^9
      cells/L), based on European cohort with hepatitis C virus (62.8%), was able to spare more
      unnecessary endoscopies than the Baveno VI criteria (40.0% vs 21.5%, p < 0.001) with VNT
      missed rate < 5%. Nevertheless, a recent Asian-pacific study indicated that though Baveno VI
      criteria was able to avoid screening endoscopy with 27.6%, it increased the odds of missing
      VNT in hepatitis B virus-related cACLD. Notably, this study also suggested that the
      expanded-Baveno VI criteria was not suited for Asian-pacific cohort with hepatitis B virus as
      the dominant cause with VNT missed rate > 5%. Our study aims to develop and validate an
      optimal cutoff value of LS and platelet count (CHESS criteria) to safely avoid more
      unnecessary endoscopies in patients with hepatitis B virus-dominated cACLD.
    

Intervention name(s): Esophagogasrtoduodendoscopy, liver stiffness measurement
Intervention type(s): Procedure
Intervention description(s): Time frame between liver stiffness measurement and esophagogastroduodendoscopy is less than 2 weeks.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patient with compensated advanced chronic liver disease
      
Keywords: Varices needing treatment; Non-invasive; Liver stiffness; Platelet count