Applying the Baveno VII Criteria for Variceal Screening to Reduce Endoscopy Costs and Risks to Patients in an Australian Referral Centre.

Baveno VII was introduced to help identify patients with compensated advanced chronic liver disease (ACLD) who should undergo screening gastroscopy to detect varices needing treatment (VNT), with a positive predictive value exceeding 90%. We performed a study at our centre to evaluate the impact of implementing this strategy, which has the potential to lower both healthcare costs and the risks associated with invasive procedures. We carried out a retrospective, single-centre analysis between 2021 and 2024, reviewing screening gastroscopies for oesophageal varices. Data reviewed included gastroscopy findings, transient elastography (TE) results performed within the preceding six months, and platelet count. The underlying cause of liver disease was also recorded. The primary aim was to evaluate the real-world application of the Baveno VII recommendations and estimate their impact on screening endoscopy utilisation and associated healthcare costs. We reviewed a total of 592 gastroscopies performed for variceal screening. Fifty-four patients were eligible for analysis after exclusion criteria were applied. Twenty-one of 54 patients (38.8%) did not meet the criteria for variceal surveillance. Notably, five out of these 21 patients (23.8%) were found to have VNT. Among the 33 patients who did meet the screening criteria, the positive predictive value for detecting VNT was 48.5% in our cohort. Applying the Baveno VII criteria would have excluded 16 patients who ultimately did not have VNT, potentiating cost savings of 29,120 Australian dollars (AUD). Application of the Baveno VII criteria in our cohort could have reduced unnecessary screening gastroscopies, resulting in cost savings and reduced procedural risk to patients. Although a small number of patients outside the screening criteria were found to have varices needing treatment, these findings should be interpreted in the context of the study's retrospective design, single-centre setting, and limited sample size. Nevertheless, this study provides a real-world example of the potential for Baveno VII-guided screening to reduce healthcare utilisation, costs, and patient exposure to invasive procedures.