EVendo Score for Predicting Esophageal Varices
Non-invasive score to predict the presence of oesophageal varices (OV) in patients with chronic liver disease or cirrhosis, avoiding unnecessary endoscopy. Based on platelet count, spleen diameter, and albumin. Score below 3.90 has high negative predictive value (NPV) for ruling out varices needing treatment (VNT). From Marot et al. 2019.
Score interpretation
EVendo at or below 3.90 -- low probability of varices needing treatment; endoscopy may be deferred
→ May avoid immediate endoscopy if no other indications (haematemesis, decompensation); consider annual surveillance endoscopy per EASL/BSG guidelines for compensated cirrhosis; ensure continued monitoring: FIB-4, FBC for platelet trend, USS liver every 6 months for HCC surveillance; if platelet count rises or spleen diameter decreases (indicating portal pressure reduction), reassess; discuss with hepatologist; note: EVendo does not replace endoscopy if there are alarm symptoms (haematemesis, melaena, decompensation).
EVendo above 3.90 -- varices likely present; endoscopy recommended
→ Upper GI endoscopy recommended to assess for oesophageal varices; grade varices (small/medium/large) per Baveno VII; if high-risk varices (F2/F3, red wale signs): start primary prophylaxis -- non-selective beta-blocker (propranolol 20 mg BD, titrate to heart rate 55-60 bpm, or carvedilol 6.25 mg OD); alternative: band ligation (EVL) if beta-blockers contraindicated or intolerant; counsel patient on signs of variceal haemorrhage (haematemesis, melaena); alcohol abstinence if ALD; repeat endoscopy in 12-24 months per BSG/EASL guidelines.
Interpretation bands for the EVendo Score. Apply clinical judgement and local guidance.
References
- Marot A et al. EVendo score: a clinical tool for the non-invasive assessment of oesophageal varices in patients with liver cirrhosis. United European Gastroenterol J. 2019;7(4):485-495.
- de Franchis R, Bosch J et al. Baveno VII -- Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-974.
Related
Curated clinical cross-links plus same-class fallbacks.
- Propranolol (Portal Hypertension) · Antihypertensive
- Carvedilol (Portal Hypertension) · Non-Selective Beta-Blocker with Alpha₁-Blocking Activity
- Selexipag · Pulmonary Arterial Hypertension
- Macitentan · Pulmonary Arterial Hypertension
- Spironolactone (Ascites / Cirrhosis) · Aldosterone Antagonist / Potassium-Sparing Diuretic
- Furosemide (Ascites / Cirrhosis) · Loop Diuretic
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.