CHESS Criteria for Varices Screening in Compensated Advanced Chronic Liver Disease (CHESS2001/APPHA2001)

Summary

Variceal hemorrhage is the serious complication in patients with compensated advanced chronic liver disease (cACLD). To evaluate the bleeding risk of varices in cACLD, esophagogastroduodenoscopy (EGD) should be performed. Once identified with medium-large varices, or small varices with red signs or Child-Pugh C class, defined as varices needing treatment (VNT), the patients with cACLD are recommended to receive the non-selective beta blockers or endoscopic variceal ligation per Baveno VI consensus. However, EGD is limited by its invasiveness and uncomfortableness. The Baveno VI criteria, which was validated by 310 patients dominant with hepatitis C virus (55.0%), recommended that EGD could be spared in patients with liver stiffness (LS) \< 20kPa and platelet count \> 150×10\^9 cells/L. Furthermore, the expanded-Baveno VI criteria (LS \< 25kPa and platelet count \> 110×10\^9 cells/L), based on European cohort with hepatitis C virus (62.8%), was able to spare more unnecessary endoscopies than the Baveno VI criteria with VNT missed rate \< 5%. Nevertheless, a recent Asian-pacific study indicated that though Baveno VI criteria was able to avoid screening endoscopy with 27.6%, it increased the odds of missing VNT in hepatitis B virus-related cACLD. Notably, this study also suggested that the expanded-Baveno VI criteria was not suited for Asian-pacific cohort with hepatitis B virus as the dominant cause with VNT missed rate \> 5%. Our study aims to develop and validate an optimal cutoff value of LS and platelet count (CHESS criteria) to safely avoid more unnecessary endoscopies in patients with hepatitis B virus-dominated cACLD.

Conditions

• Compensated Advanced Chronic Liver Disease
• Varices Needing Treatment

Interventions

PROCEDURE

Esophagogasrtoduodendoscopy, liver stiffness measurement

Time frame between liver stiffness measurement and esophagogastroduodendoscopy is less than 2 weeks.

Sponsors & Collaborators

• LanZhou University

  collaborator OTHER

• Tianjin Second People's Hospital

  collaborator OTHER

• The Sixth People's Hospital of Shenyang

  collaborator OTHER

• Ankang Central Hospital

  collaborator OTHER

• Guangxi Zhuang Autonomous Region

  collaborator UNKNOWN

• Dalian Sixth People's Hospital

  collaborator UNKNOWN

• Xingtai People's Hospital

  collaborator OTHER

• Shanghai Tongji Hospital, Tongji University School of Medicine

  collaborator OTHER

• Seventh Medical Center of PLA Army General Hospital

  collaborator OTHER

• Zhujiang Hospital

  collaborator OTHER

• The Fifth Affiliated Hospital of Zunyi Medical College

  collaborator OTHER

• Sir Run Run Shaw Hospital

  collaborator OTHER

• Beijing Tsinghua Changgeng Hospital

  collaborator OTHER

• The Central Hospital of Lishui City

  collaborator OTHER

• The Affiliated Third Hospital of Jiangsu University

  collaborator UNKNOWN

• Hepatopancreatobiliary Surgery Institute of Gansu Province

  lead OTHER

Principal Investigators

• Jiahong Dong, M.D. · Beijing Tsinghua Changgeng Hospital

• Xiaolong Qi, M.D. · LanZhou University

• Liting Zhang, M.D. · LanZhou University

• Lin Zhang, M.D. · Beijing Tsinghua Changgeng Hospital

• Fengmei Wang, M.D. · Tianjin Second People's Hospital

• Ye Gu, M.D. · The Sixth People's Hospital of Shenyang

• Zicheng Jiang, M.D. · Ankang Central Hospital

• Guo Zhang, M.D. · Guangxi Zhuang Autonomous Region

• Yong Zhang, M.D. · Dalian Sixth People's Hospital

• Dengxiang Liu, M.D. · Xingtai People's Hospital

• Li Yang, M.D. · Shanghai Tongji Hospital, Tongji University School of Medicine

• Shuai Wang, M.D. · Seventh Medical Center of PLA Army General Hospital

• Hua Mao, M.D. · Zhujiang Hospital

• Chaohui He, M.D. · The Fifth Affiliated Hospital of Zunyi Medical College

• Weiling Hu, M.D. · Sir Run Run Shaw Hospital

• Shengqiang Zou, M.D. · The Affiliated Third Hospital of Jiangsu University

• Chuxiao Shao, M.D. · The Central Hospital of Lishui City

Eligibility

Min Age

18 Years

Max Age

75 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2020-03-18

Primary Completion

2023-03-17

Completion

2023-03-17

Countries

• China

Study Locations