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Hepatobiliary SurgeryManagement

Portal Hypertension Management - Baveno VII

Portal Hypertension Management - Baveno VII: Chronic Liver Disease → CSPH Assessment → Baveno VI/VII Rule to Avoid EGD → Can Defer EGD.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. ▶
    Start

    Chronic Liver Disease

    Cirrhosis or advanced fibrosis

    1. ●
      Action

      CSPH Assessment

      Clinically significant portal hypertension

      • HVPG ≥10 mmHg if measured
      • Non-invasive: LSM ≥20-25 kPa (suggests CSPH)
      • Baveno VI criteria for avoiding EGD
      1. ◆
        Decision

        Baveno VI/VII Rule to Avoid EGD

        • LSM <20 kPa AND platelets >150k
        • Low risk of varices needing treatment
        • If met: can defer EGD, repeat assessment yearly
        1. ●
          Action

          Can Defer EGD

          Low risk, annual reassessment

        2. ●
          Action

          EGD Recommended

          Screen for varices

          1. ◆
            Decision

            Varices on EGD

            • No varices
            • Small varices (<5mm, no red signs)
            • Medium/large varices or red signs
            1. ●
              Action

              No/Small Varices without Red Signs

              Primary prophylaxis options

              • NSBB (carvedilol) if CSPH confirmed
              • Or repeat EGD in 1-2 years
              • Treat underlying etiology
              1. ●
                Action

                NSBB Therapy

                Carvedilol 6.25-12.5mg BID or propranolol

                • Target: HR ~55-60, no hypotension
                • Continue indefinitely if tolerated
                • Stop if refractory ascites/hypotension
                1. ■
                  End

                  Ongoing Surveillance

                  Monitor for bleeding, ascites, consider transplant evaluation

            2. ●
              Action

              High-Risk Varices

              Medium/large or red signs

              • Primary prophylaxis mandatory
              • NSBB (carvedilol preferred)
              • OR EVL (band ligation)
              • TIPS if refractory
              1. ●
                Action

                EVL (Band Ligation)

                If NSBB contraindicated/intolerant

                • Repeat q2-4 weeks until eradicated
                • Then surveillance EGD

Guideline Source

Baveno VII Consensus on Portal Hypertension

DOI: 10.1016/j.jhep.2021.12.003View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • HVPG measurement gold standard but invasive
  • Non-invasive tools (elastography, platelets) increasingly used
  • NSBB indicated once varices or CSPH confirmed
  • Carvedilol preferred over propranolol in many settings

Applicable Regions

USAUUKEU

EU: Baveno VII consensus

US: AASLD portal hypertension guidelines

Version 1Next review: 2028-01-01

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Acute Pancreatitis Surgical Timing - IAP/APA Guidelines

Management

Acute Variceal Hemorrhage Management (Baveno VII 2022)

Emergency

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Frequently Asked Questions

What is the Portal Hypertension Management - Baveno VII?

The Portal Hypertension Management - Baveno VII is a management clinical algorithm for Hepatobiliary Surgery. It provides a structured decision tree to guide clinical decision-making, based on Baveno VII Consensus on Portal Hypertension.

What guideline is the Portal Hypertension Management - Baveno VII based on?

This algorithm is based on Baveno VII Consensus on Portal Hypertension (DOI: 10.1016/j.jhep.2021.12.003).

What are the limitations of the Portal Hypertension Management - Baveno VII?

Known limitations include: HVPG measurement gold standard but invasive; Non-invasive tools (elastography, platelets) increasingly used; NSBB indicated once varices or CSPH confirmed; Carvedilol preferred over propranolol in many settings. Individual patient factors may require deviation from these recommendations.

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