Baveno VI Recommendation on Avoidance of Screening Endoscopy in Cirrhotic Patients: Not Quite There Yet!

In 2015, the Baveno VI consensus report introduced some new concepts in the world of hepatology, namely the definition of compensated advanced chronic liver disease (cACLD) and the use of noninvasive methods to avoid screening of varices in these patients in the absence of ongoing liver injury. cACLD reflects the spectrum of severe fibrosis or cirrhosis as a continuum in asymptomatic patients, indistinguishable on clinical grounds. Patients with cACLD, liver stiffness <20 kPa, and platelet count >150,000 were considered at low risk for having varices requiring primary prophylaxis, consequently avoiding endoscopy screening, irrespective of etiology. Furthermore, the report states that regarding patients with virus-related cACLD, noninvasive methods can sufficiently rule in CSPH alone or combined with platelet count and spleen size [9] . The Baveno VI report regarding endoscopy surveillance in cACLD patients was not based upon robust data and remains a matter of controversy and debate. Nevertheless, following its publication, many centers published their retrospective data validating the report [10–13] . Data from a cohort of 310 patients from 2 centers in London showed that the Baveno VI report spared endoscopy surveillance in 33% of patients. This is the largest cohort of patients with different etiologies (55% viral) validating