What are the management steps for liver cirrhosis based on the Beveno (Baveno) 7 criteria?

From the Guidelines

For patients with liver cirrhosis, the Baveno VII criteria should be applied to determine the need for endoscopic surveillance, with a focus on screening for varices and preventing bleeding, as recommended by the most recent and highest quality study 1. To apply the Baveno VII criteria, patients with compensated cirrhosis should undergo initial risk stratification using liver stiffness measurement (LSM) by elastography and platelet count.

• Those with LSM <20 kPa and platelets >150,000/μL can safely avoid endoscopy as they have a low risk of varices needing treatment, according to the Baveno VI criteria expanded by Augustin et al. and supported by 1.
• For patients not meeting these criteria, perform an upper endoscopy to assess for varices, as noninvasive screening for varices that need to be treated is not particularly reliable, especially in Korea, as noted in 1. Some key points to consider in the management of liver cirrhosis include:
• The use of non-selective beta-blockers (NSBBs) like propranolol or carvedilol for small varices, as recommended by various guidelines and studies, including 1.
• The importance of urgent endoscopy within 12 hours for patients with decompensated cirrhosis or acute variceal bleeding, as emphasized in 1.
• The need for a comprehensive approach to managing cirrhosis, including care coordination programs and educational programs for patients and caregivers, as highlighted in 1 and 1. However, it is essential to prioritize the most recent and highest quality study, which in this case is 1, to ensure that the recommendations are based on the latest evidence and guidelines. The Baveno VII criteria should be applied to determine the need for endoscopic surveillance, with a focus on screening for varices and preventing bleeding, to improve morbidity, mortality, and quality of life outcomes in patients with liver cirrhosis, as supported by the latest evidence 1.

From the Research

Beveno 7 Criteria for Liver Cirrhosis

The Beveno 7 criteria are not explicitly mentioned in the provided studies. However, the studies discuss the diagnosis and management of liver cirrhosis, which may be related to the Beveno 7 criteria.

Diagnosis and Management of Liver Cirrhosis

• Liver cirrhosis can be diagnosed with a history, physical examination, and noninvasive testing, including laboratory tests, combination scoring indices, and imaging 2.
• Liver biopsy remains the reference standard for diagnosis and should be used when results of noninvasive evaluation are indeterminate, when the etiology of liver disease remains unknown, or when the result may alter management 2.
• Clinicians should counsel patients about alcohol use, obesity management, and prevention of infection, and avoid drugs with potential for hepatotoxicity 2.
• Clinical assessment with laboratory tests and calculation of the Child-Pugh and Model for End-stage Liver Disease (MELD) scores should occur every 6 months 2.

Treatment of Liver Cirrhosis Complications

• Nonselective β-blockers (carvedilol or propranolol) can reduce the risk of decompensation or death in patients with portal hypertension 3.
• Combination aldosterone antagonist and loop diuretics can resolve ascites and reduce rates of hyperkalemia 3.
• Lactulose can reduce mortality and risk of recurrent overt hepatic encephalopathy 3.
• Terlipressin can improve the rate of reversal of hepatorenal syndrome 3.
• First-line therapies for cirrhosis complications include carvedilol or propranolol to prevent variceal bleeding, lactulose for hepatic encephalopathy, combination aldosterone antagonists and loop diuretics for ascites, and terlipressin for hepatorenal syndrome 3.

Variceal Bleeding Prevention

• Beta-blockers, mainly propranolol, can significantly reduce the incidence of first variceal bleeding in patients with liver cirrhosis 4, 5.
• Endoscopic variceal ligation can also prevent variceal bleeding and is often used in combination with beta-blockers 5, 6.
• The choice of treatment for variceal bleeding prevention depends on the individual patient's risk factors and the presence of contraindications to certain treatments 5.