P50 Baveno criteria for oesophago gastro duodenoscopy endoscopy(OGDE): real world results

<h3>Background</h3> Acute variceal bleeding remains a prominent cause of mortality among patients with Compensated Liver Cirrhosis (CLC), with Oesophago-Gastro-Duodenoscopy Endoscopy (OGDE) playing a crucial role in predicting this risk. The Baveno VI recommendation guides the frequency of OGDE in these patients. This study aims to assess the real-world applicability of these guidelines and their outcomes in clinical practice. <h3>Methodology</h3> This retrospective study analyzes patients diagnosed with CLC in the United Kingdom between (2021 - 2024). Patients were categorized into two main groups: those recommended for OGDE and those not. Among patients recommended for OGDE, subgroups were formed based on the Baveno VI criteria (No varices, small varices, and large varices). The study then evaluates the difference in the rate of developing acute upper gastrointestinal bleeding among these groups. <h3>Results</h3> Out of 1,878 patients undergoing OGDE, 205 were included. Most procedures 97.7% were at Royal Stoke University Hospital, with 60% of the patients being males. 29.8% met the Baveno VI criteria for OGDE screening, chronic liver disease affected 60.2% of patients, primarily alcohol-related 32.7%. Esophageal varices were found in 57.6% of cases, with 30.2% having grade 1 and 23.4% having grade 2. Only 12.7% of the patients have been admitted due to bleeding after the OGDE, with no statistical significance between the patients who met the Baveno criteria and patients who didn’t (9.48% vs. 13.9%, p=0.570). A higher median MELD score was reported in the patients who met the Baveno criteria (9 vs. 8, p=0.049). With decreased incidence of admission due to bleeding post-OGDE for the patients diagnosed before 2020 and after (21% vs. 9.1%, p=0.036). <h3>Conclusion</h3> Our study provides valuable insights into the management of acute upper GI bleeding in patients with CLC disease undergoing OGDE. Encouragingly, our findings suggest that adherence to Baveno IV criteria may contribute to the effective prevention of acute upper GI bleeding in this population. There was no significant difference in bleeding incidence between patients recommended for OGDE and those who didn’t, decrease in the incidence of admission due to bleeding over time. <h3>References</h3> Ginès P, Krag A, Abraldes JG,<i> et al</i>. Liver cirrhosis. <i>The Lancet</i>. 2021;<b>398</b>:1359–1376. Sepanlou SG, Safiri S, Bisignano C, <i>et al</i>. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. <i>Lancet Gastroenterol Hepatol</i>. 2020;<b>5</b>:245–266. Jhan C-H, Kao W-Y, Huang Y-M. Indocyanine green fluorescence imaging-assisted laparoscopic radiofrequency ablation of hepatocellular carcinoma. <i>Clin Gastroenterol Hepatol.</i> 2023;<b>21</b>:A19–A20. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: observational study. <i>BMJ</i>. 2018;<b>362</b>:k2817. Tapper EB, Ufere NN, Huang DQ, <i>et al</i>. Review article: current and emerging therapies for the management of cirrhosis and its complications. <i>Aliment Pharmacol Ther</i>. 2022;<b>55</b>:1099–1115. Mallet M, Rudler M, Thabut D. Variceal bleeding in cirrhotic patients. <i>Gastroenterol Rep (Oxf)</i>. 2017;<b>5</b>:185–192. Merli M, Nicolini G, Angeloni S, <i>et al</i>. Incidence and natural history of small esophageal varices in cirrhotic patients. <i>J Hepatol</i>. 2003;<b>38</b>:266–272. Mansour D, Masson S, Hammond J, <i>et al</i>. British society of gastroenterology best practice guidance: outpatient management of cirrhosis – part 3: special circumstances. <i>Frontline Gastroenterol</i>. 2023;<b>14</b>:474–482.