EVendo Score for Esophageal Varices

Why Use

Helps identify those who will most benefit from variceal screening and potentially forego the risks and costs of unneeded screening endoscopy at both an individual and public health level.

When to Use

Patients >18 years of age with known or suspected cirrhosis. Do not use in patients with overt GI bleeding or with history of acute variceal hemorrhage.

Formula

Pearls / Pitfalls

Noninvasively predicts patients with low probability of any esophageal varices or varices needing treatment (defined as medium to large varices or varices with high-risk features, such as red wale marks) on screening endoscopy. Uses readily available clinical information to calculate. Likely to be less accurate in patients with conditions that, unrelated to severity of liver disease or portal hypertension, could alter the values of the EVendo score inputs (e.g. hemoglobinopathies, Coumadin use, and severe renal dysfunction). Prospectively validated in a cohort of 100 patients.

Advice

Not a substitute for an individual treatment plan developed by a clinician with personal knowledge of a specific patient. As such, it should not be used alone to determine a patient's medical treatment. Screening endoscopy may be deferred when the EVendo score is ≤3.90, and instead patients may be monitored clinically, with reassessment of the EVendo Score at a future date (e.g. in 3-6 months). If access to endoscopy is limited, patients with EVendo scores >3.90 should be prioritized to undergo screening upper endoscopy over patients with lower EVendo scores.

More Information

Interpretation: EVendo Score Probability of finding varices* Recommendation ≤3.90 <5%** Expectant management >3.90 ≥5% Endoscopy *Any esophageal varices or varices needing treatment. **95.1% sensitivity, 95.8% NPV. From Dong 2019 .