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Impact of sustained virological response with DAAs on gastroesophageal varices and Baveno criteria in HCV-cirrhotic patients.
Puigvehí, Marc; Londoño, María-Carlota; Torras, Xavier; Lorente, Sara; Vergara, Mercedes; Morillas, Rosa Maria; Masnou, Helena; Serrano, Trinidad; Miquel, Mireia; Gallego, Adolfo; Lens, Sabela; Carrión, Jose Antonio.
Afiliación
  • Puigvehí M; Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
  • Londoño MC; Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, Barcelona, Spain.
  • Torras X; Gastroenterology Department, Hospital de La Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
  • Lorente S; Liver Unit, Gastroenterology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
  • Vergara M; Liver Unit, Digestive Disease Department, Parc Taulí Sabadell Hospital Universitari, Institut D'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Sabadell, Barcelona, Spain.
  • Morillas RM; Hepatology Department, Hospital Germans Trias i Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Barcelona, Spain.
  • Masnou H; Hepatology Department, Hospital Germans Trias i Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Barcelona, Spain.
  • Serrano T; Liver Unit, Gastroenterology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
  • Miquel M; Liver Unit, Digestive Disease Department, Parc Taulí Sabadell Hospital Universitari, Institut D'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Sabadell, Barcelona, Spain.
  • Gallego A; Gastroenterology Department, Hospital de La Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
  • Lens S; Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, Barcelona, Spain.
  • Carrión JA; Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. jcarrion@parcsalutmar.cat.
J Gastroenterol ; 55(2): 205-216, 2020 Feb.
Article en En | MEDLINE | ID: mdl-31493238
BACKGROUND: Direct-acting antivirals (DAAs) show high efficacy and safety in HCV-cirrhotic patients, but most maintain clinically significant portal hypertension after sustained virological response (SVR). Non-invasive Baveno and expanded-Baveno criteria can identify patients without high-risk gastroesophageal varices (GEV) who have no need for endoscopic surveillance. However, data after SVR are scarce. We performed a multicenter study to evaluate SVR effects over GEV and diagnostic accuracy of non-invasive criteria after SVR. METHODS: HCV-cirrhotic patients receiving DAAs and baseline endoscopic evaluation were included (November 2014-October 2015). GEV were classified as low risk (LR-GEV) (< 5 mm) or high risk (HR-GEV) (≥ 5 mm or with risk signs). Transient elastography (TE) and endoscopy were performed during follow-up. RESULTS: SVR was achieved in 230 (93.1%) of 247 included patients, 151 (65.7%) with endoscopic follow-up. Among 64/151 (42.4%) patients without baseline GEV, 8 (12.5%) developed GEV after SVR. Among 50/151 (33.1%) with baseline LR-GEV, 12 (24%) developed HR-GEV. Patients with GEV progression showed TE ≥ 25 kPa before treatment (64.7%) or ≥ 20 kPa after SVR (66.7%). Only 6% of patients without GEV and LSM < 25 kPa before treatment, and 10% of those with baseline LSM < 25 kPa and LSM < 20 kPa after SVR showed GEV progression after 36 months. The negative predictive value of Baveno and expanded-Baveno criteria to exclude HR-GEV was maintained after SVR (100% and 90.7%, respectively). CONCLUSIONS: HCV-cirrhotic patients can develop HR-GEV after SVR. Surveillance is especially recommended in those with GEV before antiviral treatment. Baveno and expanded-Baveno criteria can be safely applied after SVR. https://clinicaltrials.gov: NCT02758509.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Antivirales / Várices Esofágicas y Gástricas / Hepatitis C Crónica / Respuesta Virológica Sostenida / Cirrosis Hepática Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Gastroenterol Asunto de la revista: GASTROENTEROLOGIA Año: 2020 Tipo del documento: Article País de afiliación: España Pais de publicación: Japón
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Antivirales / Várices Esofágicas y Gástricas / Hepatitis C Crónica / Respuesta Virológica Sostenida / Cirrosis Hepática Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Gastroenterol Asunto de la revista: GASTROENTEROLOGIA Año: 2020 Tipo del documento: Article País de afiliación: España Pais de publicación: Japón