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LONG-TERM TREATMENT WITH TENOFOVIR OR ENTECAVIR
COULD SPARE ENDOSCOPIC SURVEILLANCE OF ESOPHAGEAL
VARICES IN HBV COMPENSATED CIRRHOTICS: A 10-YEAR
STUDY
Elisa Farina1, Alessandro Loglio1, Giulia Tosetti1, Mauro
Viganò2, Carmine Gentile2, Riccardo Perbellini1, Marta
Borghi1, Floriana Facchetti1, Giovanna Lunghi3, Mariagrazia
Rumi2,4, Massimo Primignani1 and Pietro Lampertico1,4, (1)
Division of Gastroenterology and Hepatology - CRC “a. M.
and a. Migliavacca” Center for Liver Disease, Foundation
Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan,
Italy, (2)Division of Hepatology, San Giuseppe Hospital,
Milan, Italy, (3)Virology Unit, Foundation Irccs Ca’ Granda
Ospedale Maggiore Policlinico, Milan, Italy, (4)Department of
Pathophysiology and Transplantation, Milan, Italy, University
of Milan
Background: Long-term administration of Tenofovir
disoproxil fumarate (TDF) or Entecavir (ETV) in CHB patients
induces excellent virological/biochemical responses and
reduces decompensation and HCC, but its effect on the
development and progression of esophageal varices (EV) it
is still unknown Aim of this study was to evaluate the risk
of EV development in compensated HBV monoinfected
cirrhotics long-term treated with TDF/ETV in a real-life setting
Methods: 186 Caucasian HBV monoinfected CPT-A HCC
free cirrhotics without EV requiring prophylaxis and with at
least one follow-up endoscopy were enrolled in a longitudinal
cohort study from TDF/ETV start and followed up to June
2020 (or liver-transplantation) every six months with blood
tests and abdominal ultrasound EV surveillance endoscopy
followed Baveno recommendations Results: At TDF/ETV
start: 61 (21-83) years-old, 80% males, 73% with normal ALT,
60% HBV DNA undetectable, 90% HBeAg negative, 63%
previously exposed to other NUCs, 12% diabetes, BMI 25
(17-40) kg/m2, liver stiffness 9 (3-60) kPa 25 (13%) patients
had low risk varices (LRV) During 136 (26-170) months of
TDF/ETV, virological response was achieved in all patients,
ALT normalized in 99%, 37 (20%) developed HCC and 4
(2%) non neoplastic portal-vein thrombosis (PVT) Overall,
666 endoscopies were performed, with a median of 3 [1-
7] per patient Out of 25 patients with LRV at baseline, 12
(48%) remained stable and 11 (44%) disappeared, while 2
(8%) patients progressed to high risk varices (HRV) (one
concomitant to HCC) Out of 161 patients with no EV at
baseline, only 7 (4%) developed EV (6 LRV and 1 HRV) after
53 (35-67) months, in 3 cases concurrent to HCC recognition
In 5 patients LRV occurred lately, after 2 negative surveillance
endoscopies at three-years interval No patient bled from
EV Overall, the 10-year cumulative probability of EV
development or worsening was 3 8% (95%CI 2-7%), while the
10-year probability of HRV onset in patients without baseline
EV was 0 6% (95%CI 0-4%) Conclusion: In compensated
HBV cirrhotics treated with TDF/ETV, the 10-year risk of
developing/worsening esophageal varices is negligible in the
absence of HCC or PVT. These findings challenge the current
recommendations of long term EV surveillance every two/
three-years.
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发表于 2020-10-25 15:55
