Gastro-hepatoloy Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
Liver Int. 2022 May;42(5):1121-1131. doi: 10.1111/liv.15210. Epub 2022 Mar 7.
BACKGROUND & AIMS: limited evidence is available to guide hepatologists regarding endoscopic surveillance of oesophageal varices (EV) in Hepatitis C Virus (HCV)-positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long-term prospective study on 427 HCV-positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs).
Patients were divided into two groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favourable Baveno VI status) and Group 2 (335, 78.5%, unfavourable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow-up of 65.2 months according to Baveno VI recommendations.
About 4.3% of Group 1 patients showed baseline EV compared with 30.1% of Group 2 patients (p < .0001). No patients belonging to Group 1 without baseline EV developed EV at follow-up endoscopy compared with 6.5% in Group 2 patients (p = .02); 69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow-up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 (p = .001). Improvement in Baveno VI status was observed in 118/335 (35.2%, p < .0001) of Group 2 patients and among those without pre-therapy EV, none developed EV throughout the follow-up.
HCV-positive cirrhotic patients cured by DAAs showing baseline favourable Baveno VI status and no worsening during follow-up can safely avoid endoscopic screening and surveillance. Patients having unfavourable Baveno VI status without baseline EV who improve their status may suspend further endoscopic surveillance.
对于丙型肝炎病毒（HCV）阳性肝硬化患者，在获得持续病毒学应答后，关于内镜监测食管静脉曲张（EV）的指南证据有限。为了解决这些问题，我们对 427 例成功接受直接抗病毒药物（DAA）治疗的 HCV 阳性肝硬化患者进行了一项长期前瞻性研究。
根据基线 Baveno VI 状态，将患者分为两组：第 1 组（92 例，21.5%，有利的 Baveno VI 状态）和第 2 组（335 例，78.5%，不利的 Baveno VI 状态）。所有患者均进行基线内镜检查，并根据 Baveno VI 建议进行中位随访 65.2 个月的内镜监测。
第 1 组患者中有 4.3%的患者基线时存在 EV，而第 2 组患者中有 30.1%的患者存在 EV（p<0.0001）。第 1 组中没有基线时无 EV 的患者在随访内镜检查时出现 EV，而第 2 组患者中有 6.5%的患者出现 EV（p=0.02）；107 例基线时存在 EV 的患者中，69 例（64.5%）为小静脉曲张。在内镜随访期间，EV 消失/改善 36 例（33.6%），稳定 39 例（36.4%），恶化 32 例（29.9%），均为第 2 组患者（p=0.001）。第 2 组患者中有 118 例（35.2%，p<0.0001）的 Baveno VI 状态得到改善，且在无治疗前 EV 的患者中，随访期间均未发生 EV。
DAA 治愈的 HCV 阳性肝硬化患者，基线时表现出有利的 Baveno VI 状态且随访期间无恶化者，可以安全避免内镜筛查和监测。基线时无 EV 且 Baveno VI 状态不利但改善的患者可暂停进一步的内镜监测。
