Long‐term endoscopic surveillance in HBV compensated cirrhotic patients treated with Tenofovir or Entecavir for 11 years

• DOI: 10.1111/apt.17463
• Publication Date: 2023-03-29T04:00:53Z
• Authors: Elisa Farina; Alessandro Loglio; Giulia Tosetti; Elisabetta Degasperi; Mauro Viganò; Carmine Gentile; Sara Monico; Riccardo Perbellini; Marta Borghi; Floriana Facchetti; Sara Colonia Uced...; Ferruccio Ceriotti; Federica Cerini; Massimo Primignani; Pietro Lampertico
• Keywords: Entecavir; Regimen; Clinical endpoint; Decompensation

Summary Background Long‐term administration of TDF/ETV in patients with HBV‐related compensated cirrhosis reduces HCC and decompensation events but the effect this regimen on development/regression oesophageal varices (EV) is currently unknown. Aim To assess risk EV development/progression population. Methods A total 186 Caucasian HBV‐monoinfected cirrhotics were enrolled a long‐term cohort study from introduction. Upper GI endoscopies performed according to Baveno recommendations. Primary endpoint was oesophageal/gastric over time. Results At start, median age 61 years, 80% males, 60% HBV‐DNA undetectable, 63% NUCs previously exposed, 73% normal ALT, 40% platelets <150,000/mmc 25 (13%) low‐risk (LRV). During 11 years antiviral therapy 666 performed, 9 either developed or had progression gastric an 11‐year cumulative probability 5.1% (95% CI 3–10%); no patient bled. Out 161 without at baseline, probably 4.5% all developing within first six treatment. In LRV regression 9.3% 58%, respectively. Only baseline platelet count (HR 0.96, p = 0.028) associated development multivariate analysis: ≤90,000/mmc (AUROC 0.70) 98.1% specificity, 42.9% sensitivity, 50% PPV for onset. Conclusions cirrhotic under effective treatment, developing/progressing negligible, thus challenging current endoscopic surveillance recommendations baseline.