The predictive value of endoscopic ultrasound for the recurrence of esophageal varices after endo-scopic esophageal varix ligation / 中华消化内镜杂志

ABSTRACT

Objective To assess the relationship between the recurrence of esophageal varices fol?lowing endoscopic esophageal varix ligation (EVL) and esophageal collateral veins(ECV)under endoscopic ultrasound ( EUS) , and analyze the predictive value of EUS for recurrence of esophageal varices. Methods Sixty patients with cirrhotic portal hypertension combined with esophageal varices underwent EVL for eradica?tion of varices. Endoscopy and EUS were performed before ligation to detect and describe the type of esopha?geal varices, and grade, location, and the number of ECV. Over a 12?month period, variceal recurrence was examined. The statistical analyses were performed to assess the relationship between esophageal varices fol?lowing EVL and ECV. Results Of the 60 patients, 29 ( 48?3%) had variceal recurrence within 12 months after EVL. Univariate logistic regression analysis showed that severe peri?ECV ( OR=22?67;95%CI4?37? 117?47, P<0?001) ,severe para?ECV( OR=16?31;95%CI0?84?108?14, P=0?018) , multiple peri?ECV ( OR=22?67;95%CI4?37?117?47, P<0?001) , and the presence of perforating veins ( OR=6?67,95%CI1?46?30?43,P=0?014) were significantly related to the variceal recurrence after EVL. Multivariate logis?tic regression model showed that severe peri?ECV ( OR=24?39;95%CI2?34?253?78,P=0?008) and mul?tiple peri?ECV (OR=24?39;95%CI 2?34?253?78,P=0?008) severe para?ECV(OR=19?42; 95%CI4?84?148?54,P=0?012) remained independent prognostic factors for variceal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence were 89?2% and 90?5%, respectively (prognostic value AUC=0?946).The sensitivity and specificity were 86?4% and 87?7% in pre?dicting variceal recurrence( prognostic value AUC=0?871) . Conclusion Recurrence rate of esophageal var?ices after EVL is high. EUS can clearly depict ECV. Severe peri?ECV and multiple peri?ECV are significant and independent prognostic factors associated with variceal recurrence risk. EUS before EVL will help predict variceal recurrence after EVL.