Non-invasive Screening of Esophageal Varices in Patients with Liver Cirrhosis

Given the invasiveness of the Esophago-Gastro-Duodenoscopy (EGD), non-tolerability, and cost, non-invasive evaluation of the patients with compensated cirrhosis is warranted. The last Baveno VI consensus has reported that compensated cirrhotic patients who have platelets count > 150.000/mm3 and liver stiffness measurement (LSM < 20 KPs) are less likely to have highrisk varices (HRVs) and can safely avoid screening EGD [1]. Other blood tests were investigated for the same purpose. Our group has assigned a new blood based score including the platelet count, serum albumin and bilirubin levels (ALBL-PLT). It was showed that ALBL-PLT score of more than three has a good predictive value in predicting HRVs among compensated cirrhotic patients. The sensitivity of the ALBL-PLT score in predicting HRVs is 100%, specificity of 78%, positive predictive value (PPV) is 80% and a negative predictive (NPV) value of 100% and AUC is 0.894. By applying this score, 84 (41.1%) patients can avoid EGD with none of them had HRVs on endoscopy [2]. In a similar cohort of patients, it was proved the beneficial effect of the ALBL-PLT score in predicting HRVs among cirrhotic patients [3]. However, most of the results of the non-invasive tests are modest and not satisfactory to replace EGD screening.