Outcomes and Recurrence Rate of Esophageal Varices after Endoscopic Treatment in Patients with Alcoholic Cirrhosis and Viral Cirrhosis

• Published in: Journal of Nippon Medical School Vol. 91; no. 2; pp. 180 - 189
• Main Authors: Furuichi, Yoshihiro, Nishiguchi, Ryohei, Shimakawa, Takeshi, Fujiwara, Tomoyuki, Sato, Koichiro, Kato, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Japan The Medical Association of Nippon Medical School 25.04.2024
• Subjects: Adult; Aged; alcoholic liver cirrhosis; Carcinoma, Hepatocellular - therapy; endoscopic injection sclerotherapy; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - therapy; esophageal varices; Female; hepatocellular carcinoma; Humans; Liver Cirrhosis - complications; Liver Cirrhosis, Alcoholic - complications; Liver Neoplasms - therapy; Male; Middle Aged; overall survival; Propensity Score; Recurrence; Retrospective Studies; Sclerotherapy - methods; Treatment Outcome; overall survival; esophageal varices; alcoholic liver cirrhosis; endoscopic injection sclerotherapy; hepatocellular carcinoma
• ISSN: 1345-4676; 1347-3409
• DOI: 10.1272/jnms.JNMS.2024_91-209

Background: The incidence of alcoholic liver cirrhosis (ALC) is increasing. However, few reports have focused on ALC-derived esophageal varices (EV). We retrospectively examined differences in overall survival (OS) and EV recurrence rate in patients after endoscopic injection sclerotherapy (EIS) for ALC and hepatic B/C virus liver cirrhosis (B/C-LC). Methods: We analyzed data from 215 patients (B/C-LC, 147; ALC, 68) who underwent EIS. The primary endpoints were OS and EV recurrence in patients with unsuccessful abstinence ALC and those with uncontrolled B/C-LC, before and after propensity score matching (PSM) to unify the patients' background. The secondary endpoints were predictors associated with these factors, as determined by multivariate analysis. Results: The observation period was 1,430 ± 1,363 days. In the analysis of all patients, OS was significantly higher in the ALC group than in the B/C-LC group (p = 0.039); however, there was no difference in EV recurrence rate (p = 0.502). Ascites and history of hepatocellular carcinoma (HCC) (p = 0.019 and p < 0.001, respectively) predicted OS, whereas age and EV size predicted recurrence (p = 0.011 and 0.024, respectively). In total, 96 patients without an HCC history were matched by PSM, and there was no significant difference in OS or EV recurrence rate (p = 0.508 and 0.246, respectively). Conclusion: When limited to patients without a history of HCC, OS and the EV recurrence rate were comparable in patients with ALC who continued to consume alcohol and those with B/C-LC without viral control.