Gut Liver.  2018 Sep;12(5):562-570. 10.5009/gnl17471.

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

• Tseng Y
• Ma L
• Luo T
• Zeng X
• Li F
• Li N
• Wei Y
• Chen S

• KMID: 2424085
• DOI: http://doi.org/10.5009/gnl17471

Abstract

BACKGROUND/AIMS
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.
METHODS
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.
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).
CONCLUSIONS
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.

Keyword

Esophageal and gastric varices; Endosonography; Cyanoacrylates; Risk assessment

MeSH Terms

Cyanoacrylates
Endosonography
Esophageal and Gastric Varices
Follow-Up Studies
Hemorrhage
Humans
Hypertension, Portal
Mortality
Odds Ratio
Risk Assessment
Ultrasonography*
Varicose Veins*
Veins
Cyanoacrylates