The role of collateral veins detected by endosonography in predicting the recurrence of esophageal varices after endoscopic treatment: a systematic review

Abstract

Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of varices is still common following endoscopic treatment. The aim was to identify predictive factors for variceal recurrence detected by endosonography. We performed a systematic review of studies published prior to June 2013. Studies analyzing gastroesophageal collateral veins as risk factors for variceal recurrence after endoscopic treatment were included. The primary outcome was to identify predictive factors for variceal recurrence investigated by endosonography. After a full-text review, 13 studies were included in our analysis. Analysis of risk factors was not possible for all studies included. Perforating veins and periesophageal collateral veins were related to a higher risk of variceal recurrence (OR = 3.93; 95 % CI 1.06-14.51; I (2) = 96 %; OR = 2.29; 95 % CI 1.58-3.33; I (2) = 55 %). Analysis of cardiac intramural veins and paragastric/cardiac collateral veins showed the same trend, but without reaching statistical significance because of the small group size and wide CI (OR = 3.72; 95 % CI 0.14-101.53; I (2) = 91 %; OR = 1.85; 95 % CI 0.84-4.07; I (2) = 0 %). Analysis of other collateral veins as risk factors for variceal recurrence and analysis of risk factors with regard to the endoscopic treatment method was not possible because of the limited number of cases and different methodologies. A positive association between variceal recurrence and type and grade of collateral veins, investigated by endosonography, was demonstrated. Endosonography is a promising tool for predicting recurrence of esophageal varices following endoscopic treatment. These findings should be interpreted with caution because of the heterogeneity of the studies.

Endoscopic ultrasonography - emerging applications in hepatology

“…Since the previous reports about the role of collaterals in patients with portal hypertension and its clinical significance, some studies have analyzed the role of the EUS in the evaluation of the outcome of endoscopic therapeutics for esophageal varices, thereby allowing the selection of these patients for more intensive therapy or follow-up[ 33 ].…”

The role of EUS in diagnosis and treatment of liver disorders

“…EUS has a predictive value identifying rebleeding risk from esophageal varices by evaluating the type and grade of esophageal collaterals and cardiovascular structures 80 119 120 . Collateral vessels in the vicinity of gastric cardia improve after endoscopic variceal ligation (EVL), indicating that esophageal varices can be treated by EVL even though they connect with cardia varices.…”

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

“… 20 Several studies have investigated the correlation between collateral circulation, a result of increased portal pressure, and the recurrence of gastroesophageal varices. 21 – 24 Currently, no reliable predictor is available to stratify the efficacy of secondary prophylactic endoscopic treatment, especially in patients with repeated endoscopy session. The purpose of this research is to investigate different extraluminal EUS phenomenon in attempt to differentiate patient response to endoscopic therapy for gas-troesophageal varices.…”