Abstract
BackgroundGastroesophageal varices (GOV) are a life-threatening complication in chronic liver disease. A method for non-invasively predicting GOV is crucial for management. This study aimed to determine whether a vein-viewing application can detect abdominal wall varices (AWV) and elucidate the relationship between AWV and GOV.MethodsOne-hundred patients with chronic liver diseases were prospectively enrolled. All the patients underwent esophagogastroduodenoscopy within three months of the enrollment. Unmanipulated images (UI) and vein-weighted images (VWI) were taken for assessing AWV by a vein-viewing application on iPhone. Two doctors independently evaluated both image types. We defined the grading of both UI and AWV as grade 0 (non-detectable), grade 1 (slightly detectable), and grade 2 (distinct).ResultsThe causes of liver diseases among the 71 men and 29 women (median age, 70.5 yr) included Hepatitis B (n = 19), Hepatitis C (n = 21), alcoholism (n = 33), primary biliary cholangitis (n = 3), autoimmune hepatitis (n = 4) and others (n = 20). GOV was indicated in 60 patients, and half of them had not been treated previously (non-treated). VWI could significantly visualize AWV than UI (72% vs. 24%, p = 0.0005). The presence of cirrhosis (chronic hepatitis vs. cirrhosis = 64.6% vs. 91.4%, p = 0.004) and GOV (52.3% vs. 74.3%, p = 0.032) were significantly higher in the VWI-AWV grade 2 group. Multivariate analysis demonstrated that VWI-AWV grade 2 was an independent factor related to the presence of non-treated GOV [OR = 3.05 (1.24–7.53), p = 0.016].ConclusionsThe vein-viewing application non-invasively detected AWV related to the presence of cirrhosis and GOV, and VWI-AWV grade 2 was an independent factor related to the presence of non-treated GOV.
Highlights
Gastroesophageal varices (GOV) are a life-threatening complication in chronic liver disease
One-hundred patients [71 men, 29 women, median age, 70.5 years] were enrolled in this study. Their liver diseases were induced by the hepatitis B virus (HBV) (n = 19), hepatitis C virus (HCV) (n = 21), alcohol (n = 33), primary biliary cholangitis (PBC) (n = 3), autoimmune hepatitis (AIH) (n = 4), and others (e.g. Budd-Chiari syndrome and cryptogenic) (n = 20)
Gastric varices were detected in 24 patients, and the form was classified into F1 (n = 14), F2 (n = 7), F3 (n = 3), respectively
Summary
Gastroesophageal varices (GOV) are a life-threatening complication in chronic liver disease. A method for non-invasively predicting GOV is crucial for management. Gastroesophageal varices (GOV) are present in about half of the patients with cirrhosis [1]. No recommendations on screening of GOV has been made in Japan [4]. Many less invasive methods for screening of GOV have been investigated [5]. The updated Baveno VI guidelines recommend that screening EGD can be avoided in patients with compensated advanced chronic liver disease who have liver stiffness < 20 kPa and a platelet count > 150,000/mm3 [16]
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