Patient Response to Endoscopic Therapy for Gastroesophageal Varices Based on Endoscopic Ultrasound Findings

• Published in: Gut and liver Vol. 12; no. 5; pp. 562 - 570
• Main Authors: Tseng, Yujen, Ma, Lili, Luo, Tiancheng, Zeng, Xiaoqing, Li, Feng, Li, Na, Wei, Yichao, Chen, Shiyao
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01.09.2018; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Aged; cyanoacrylates; endosonography; Endosonography - methods; Endovascular Procedures - methods; Endovascular Procedures - statistics & numerical data; esophageal and gastric varices; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - prevention & control; Esophageal and Gastric Varices - surgery; Female; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - prevention & control; Gastrointestinal Hemorrhage - surgery; Humans; Hypertension, Portal - complications; Male; Middle Aged; Original; Recurrence; Retrospective Studies; risk assessment; Secondary Prevention - methods; Treatment Outcome; 내과학; Cyanoacrylates; Endosonography; Risk assessment; Esophageal and gastric varices
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl17471

Gastroesophageal variceal hemorrhage is a common complication of portal hypertension. Endoscopic therapy is currently recommended for preventing gastroesophageal variceal rebleed. However, the rate of variceal rebleed and its associated mortality remain concerning. This study is aimed at differentiating patient response to endoscopic therapy based on endoscopic ultrasound (EUS) findings. One-hundred seventy patients previously treated with repeat endoscopic therapy for secondary prophylaxis were enrolled and classified into two groups based on treatment response. Prior to consolidation therapy, all patients received an EUS examination to observe for extraluminal phenomena. All available follow-up endoscopic examination records were retrieved to validate study results. Of the 170 subjects, 106 were poor responders, while 64 were good responders. The presence of para-gastric, gastric perforating, and esophageal perforating veins was associated with poor patient response (p<0.001). The odds ratio for para-gastric veins was 5.374. Follow-up endoscopic findings for poor responders with incomplete variceal obliteration was closely correlated with the presence of para-gastric veins (p=0.002). The presence of para-gastric veins is a characteristic of poor response to endoscopic therapy for treating gastroesophageal varices. Early identification of this subgroup necessitates a change in course of treatment to improve overall patient outcome.