Baveno VI and VII criteria are not suitable for screening for large varices or clinically significant portal hypertension in patients with hepatocellular carcinoma

Summary Background Baveno VI and VII criteria are used in patients with cirrhosis to rule out large size oesophageal varices (EV) and rule in/out clinically significant portal hypertension (CSPH). Aim To evaluate their diagnostic performance in these patients. Methods We retrospectively included all patients with Child‐Pugh A cirrhosis and HCC who had endoscopy, liver stiffness measurement (LSM) and platelet count within 6 months. They were classified according to the BCLC stage. Favourable Baveno VI criteria were defined by LSM < 20 kPa and platelets > 150 G/L (to rule out large EV), favourable Baveno VII criteria if LSM ≤ 15 kPa and platelets ≥ 150 G/L (to rule out CSPH, which was defined by a HVPG ≥ 10 mm Hg. Results We included 185 patients; 46% were BCLC‐0/A, 28% BCLC‐B and 26% BCLC‐C. EV were present in 44% (23% large), and HVPG ≥ 10 mm Hg in 42% (mean 8 mm Hg). In patients with favourable Baveno VI criteria, 8% of the whole cohort (Se 93%, NPV 92%), 11% of BCLC‐0‐A (Se 89%, NPV 89%) and 10.0% of BCLC‐C patients (Se 91%, NPV 90%) had large EV. Among patients with HVPG < 10 mm Hg, 6% had large EV and 17% small. CSPH was present in 23% of patients with favourable Baveno VII criteria among the whole cohort, and in 25% of those with BCLC‐0/A. The specificity of LSM ≥ 25 kPa to rule in CSPH was 48%. Conclusions Favourable Baveno VI criteria are not appropriate to rule out the presence of high‐risk EV, or Baveno VII criteria to rule CSPH in/out in patients with HCC.