Esophageal collateral veins in predicting esophageal variceal recurrence and rebleeding after endoscopic treatment: a systematic review and meta-analysis

Li, Qianqian; Li, Hongyu; Bai, Zhaohui; Philips, Cyriac Abby; Guo, Xiaozhong; Qi, Xingshun

doi:10.1093/gastro/goaa004

Cited by 8 publications

(7 citation statements)

References 43 publications

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“…Esophageal varices, which refer to tortuously dilated esophageal veins [ 42 ], are one of the main complications of portal hypertension [ 43 ], and esophageal variceal bleeding is one of the most common causes of death in liver cirrhosis [ 44 , 45 ]. About 30% of patients with liver cirrhosis develop esophageal variceal bleeding [ 42 ].…”

Section: Evaluation Of Spss On Ctmentioning

confidence: 99%

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Xingshun

Guo

Zeng

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Spontaneous portosystemic shunt (SPSS) refers to collateral vessels that communicate between the portal vein system and systemic circulation. SPSS mainly includes esophageal varices, gastric varices, left gastric vein, recanalized paraumbilical vein, abdominal wall varices, and spontaneous splenorenal shunt. SPSS contributes to the development of hepatic encephalopathy caused by portal vein inflow bypassing and carries a higher risk of death in liver cirrhosis. Abdominal contrast-enhanced computed tomography is a major imaging approach to establish a diagnosis of SPSS and evaluate its location and feature. This review primarily describes the main contrast-enhanced CT features of SPSS in liver cirrhosis.

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Section: Evaluation Of Spss On Ctmentioning

confidence: 99%

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Xingshun

Guo

Zeng

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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“…e present study also found that a low PLT count was associated with ECVs, which further suggested that the presence of ECVs should be in parallel with the severity of portal hypertension. Most previous studies have suggested that the presence of ECVs may be associated with the recurrence of EVs [9]. However, it is possible that portal pressure can be reduced by ECVs as collateral vessels.…”

Section: Discussionmentioning

confidence: 96%

“…Most previous studies have suggested that the presence of ECVs may be associated with the recurrence of EVs [ 9 ]. However, it is possible that portal pressure can be reduced by ECVs as collateral vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal collateral veins (ECVs) refer to the portosystemic collateral vessels outside the esophageal lumen [5]. Individual studies and meta-analyses by our and other teams suggest a high prevalence of ECVs in patients with portal hypertension and a remarkable impact of ECVs on the recurrence of EVs [6][7][8][9]. However, the risk factors for developing ECVs remained unclear.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Esophageal Collateral Veins in Cirrhosis with and without Previous Endoscopic Esophageal Variceal Therapy

Guo

Feng

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background. Portosystemic collateral vessels are a sign of portal hypertension in liver cirrhosis. Esophageal collateral veins (ECVs) are one major type of portosystemic collateral vessels, which increase the recurrence of esophageal varices and bleeding after variceal eradication. However, the risk factors for ECVs were still unclear. Methods. We retrospectively screened cirrhotic patients who had contrast-enhanced computed tomography (CT) images to evaluate ECVs and upper gastrointestinal endoscopic reports to evaluate gastroesophageal varices at our department. Univariate and multivariate logistic regression analyses were performed to explore the independent risk factors for ECVs. Odds ratios (ORs) were calculated. Subgroup analyses were performed in patients with and without previous endoscopic variceal therapy which primarily included endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). Results. Overall, 243 patients were included, in whom the prevalence of ECVs was 53.9%. The independent risk factors for ECVs were hepatitis C virus infection (OR = 0.250, p = 0.026), previous EVL (OR = 1.929, p = 0.044), platelet (OR = 0.993, p = 0.008), and esophageal varices needing treatment (EVNTs) (OR = 2.422, p = 0.006). The prevalence of ECVs was 60.8% (73/120) in patients undergoing EVL, 50% (10/20) in those undergoing EIS, and 47.5% (48/101) in those without previous endoscopic variceal therapy. The independent risk factors for ECVs were the use of nonselective beta-blockers (OR = 0.294, p = 0.042) and EVNTs (OR = 3.714, p = 0.006) in subgroup analyses of patients with and without previous endoscopic variceal therapy, respectively. Conclusions. The presence of ECVs should be closely associated with the severity of portal hypertension in liver cirrhosis. Risk of ECVs might be increased by previous EVL.

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“…Third, the cases examined for this study included patients who had treatment. Regarding observation using EUS, blood vessels outside the esophageal wall are known to be involved in variceal recurrence [ 20 , 21 ]. The presence or absence of development of such blood vessels is believed to be involved in the occurrence of bleeding in patients with F1 varices with RC-positivity.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Bleeding in Small/Straight Esophageal Varices with Red Color Sign on Endoscopy: A Retrospective Analysis from the Natural Course

et al. 2022

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Red color sign-positive (RC-positive) esophageal varices present a high bleeding risk, necessitating prophylactic treatment. Among RC-positive esophageal varices, those classified morphologically as small straight varices (Form level 1: F1) are difficult to treat. Moreover, the appropriate time for therapeutic intervention remains undefined. This study assessed the bleeding risk in RC-positive F1 esophageal varices. After extracting 541 cases of F1 esophageal varices diagnosed during 1 January 2012–29 February 2020, 76 cases of RC-positive F1 esophageal varices were divided into two groups in terms of treatment intervention at diagnosis: 49 cases with (treatment group) and 27 cases without (follow-up group). We assessed the bleeding rates, bleeding-associated factors, and early-bleeding-associated factors. The treatment group’s bleeding rate was 10% (5/49). The follow-up group’s bleeding rate was 78% (21/24). The subsequent bleeding rate was low in the treatment group (p < 0.001). The median period of sustained absence of bleeding was longer in the treatment group than in the follow-up group (1156 [274–1582] days vs. 105 [1–336] days; p < 0.001). In the follow-up group, a significant number of bleedings had varices that included a hematocystic spot (HCS) as RC or combined with RC (p = 0.017). Early bleeding occurred often in varices that included HCS or combined with RC (p = 0.024). Red wale marking (RWM) only was not a factor of early bleeding (p = 0.012). In conclusion, RC-positive varices should be treated even as F1 varices. Patients with RWM only show the possibility of not accepting early treatment intervention. A fast response is crucially important in HCS cases because of its associated bleeding and early bleeding.

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Esophageal collateral veins in predicting esophageal variceal recurrence and rebleeding after endoscopic treatment: a systematic review and meta-analysis

Cited by 8 publications

References 43 publications

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis

Risk Factors for Esophageal Collateral Veins in Cirrhosis with and without Previous Endoscopic Esophageal Variceal Therapy

The Risk of Bleeding in Small/Straight Esophageal Varices with Red Color Sign on Endoscopy: A Retrospective Analysis from the Natural Course

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