Baveno VII Renewing Consensus
- Update 2021 -

These new Baveno VII guidelines further reinforce the use of FibroScan^® for the management of patients with advanced chronic liver disease.

➜ LSM by VCTE™ is presented as the cornerstone NIT for both better risk stratification and improved clinical decision making for patients at risk of cACLD, CSPH and esophageal varices.

➜ LSM by VCTE™ is now also recommended for the monitoring of cACLD patients, with clear cut-offs provided to identify substantially reduced risk of decompensation and liver-related death.

➜ Like recent EASL guidelines, Baveno VII new guidelines are also introducing recommendations on spleen stiffness, with for the first-time cut-offs for SSM by VCTE™.

➜ All these cut-offs are specific to our FibroScan^® technologies, providing an even stronger level of support for the use of our solutions in specialized centers.

➜ These Baveno VII guidelines will have a global impact, being endorsed by many societies across the world including EASL and AASLD.

➜ Same as Baveno VI, there is no mention of cut-offs by other shear wave elastography technologies (2D-SWE & pSWE) in these new Baveno VII guidelines, on both liver stiffness & spleen stiffness.

• LSM values by TE <10 kPa in the absence of other known clinical/imaging signs rule out cACLD; values between 10 and 15 kPa are suggestive of cACLD;
values >15 kPa are highly suggestive of cACLD.

• A rule of five for LSM by TE (10-15-20-25 kPa) should be used to denote progressively higher relative risks of decompensation and liver-related death independently of the etiology of CLD. (See figure 1)

• LSM by TE ≤15 kPa plus platelet count ≥ 150×10⁹/L rules out CSPH in cACLD patients.

• In patients with virus and/or alcohol related cACLD and non-obese (BMI <30 kg/m²) NASH cACLD, a LSM value by E ≥25 kPa is sufficient to rule in CSPH.

• Patients with compensated cirrhosis not candidates for initiating NSBB for the prevention of decompensation should undergo an endoscopy for variceal screening if LSM by TE ≥20 kPa or platelet count ≤150×10⁹/L.

• LSM could be repeated every 12 months to monitor changes.

• A clinically significant decrease in LSM, which is associated with substantially reduced risk of decompensation and liver-related death, can be defined as a decrease in LSM of ≥20% associated with LSM<20 kPa or any decrease to a LSM<10 kPa.

• Patients avoiding screening endoscopy can be followed up by yearly repetition of TE and platelet count. If LSM increases (≥ 20 kPa) or platelet count declines (≤150×10⁹/L), these patients should undergo screening endoscopy.

• SSM using TE can be used in cACLD due to viral hepatitis (untreated HCV; untreated and treated HBV) to rule-out and rule-in CSPH (SSM<21 kPa and SSM>50 kPa, respectively).

• SSM ≤40 kPa by TE can be used to identify subject at low probability of high-risk varices, in whom endoscopy can be avoided.