Screening and surveillance of esophageal varices in patients with HCV-positive liver cirrhosis successfully treated by direct acting antiviral agents

Background and aims: limited evidence is available to guide hepatologists regarding endoscopic surveillance of esophageal varices (EV) in Hepatitis C Virus (HCV)-positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long-term prospective study on 427 HCV-positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs). Methods: patients were divided into 2 groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favorable Baveno VI status) and Group 2 (335, 78.5%, unfavorable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow-up of 65.2 months according to Baveno VI recommendations. Results: 4.3% of group 1 patients showed baseline EV compared with 30.1% of group 2 patients (p<0.0001). No patients belonging to group 1 without baseline EV developed EV at follow-up endoscopy compared with 6.5% in group 2 patients (p= 0.02); 69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow-up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 (p= 0.001). Improvement in Baveno VI status was observed in 118/335 (35.2%, p<0.0001) of Group 2 patients and among those without pre-therapy EV, none developed EV throughout the follow-up. Conclusions: HCV-positive cirrhotic patients cured by DAAs showing baseline favorable Baveno VI status and no worsening during follow-up can safely avoid endoscopic screening and surveillance. Patients having unfavorable Baveno VI status without baseline EV who improve their status may suspend further endoscopic surveillance.