S2835 Low Risk of Decompensation in Adults With Compensated Chronic Liver Disease

Introduction: Endoscopic screening for esophageal varices (EV) in patients with cirrhosis is invasive, costly, and can usually be avoided in patients who meet the low-risk Baveno criteria (liver stiffness <20 kPa and platelets >150 × 10⁹/L). The rate of transition from compensated to decompensated liver disease is about 5%-7% each year. Our goal was to evaluate the temporal trends in EV screening and the risk of decompensation in the context of evolving portal hypertension guidelines at a large American liver clinic. Methods: We performed a single-center retrospective cohort study of adults with compensated advanced chronic liver disease seen in January to March of the following years: 2014, 2018, and 2022. We used descriptive statistics to characterize the study population. We calculated the proportion of patients who had a decompensation within 3 years and assessed their characteristics. Results: We found a low rate of decompensations at 1.6% within 3 years for patients with compensated chronic liver disease. There were a total of 2 out of 124 patients that decompensated, one related to progression of hepatocellular carcinoma resulting in liver failure and death within 6 months of the visit. This patient had platelets of 143 × 109/L was not on a NSBB and did not have esophageal varices on a recent EGD. Another patient had platelets of 130 × 109/L, was on nadalol, grade 2 non-bleeding esophageal varices, with no intervention and had a gastric variceal bleed about 6 months after screening. Conclusion: Patients with compensated chronic liver disease are at very low risk of decompensations and are being over screened for esophageal varices. Patients with criteria for clinically significant portal hypertension will benefit from non-invasive management and the recommended initiation of NSBB from Baveno VII guidelines. Future work will look at temporal changes with 2024 data.