Value of endoscopic ultrasonography for risk assessment in esophageal varices bleeding

Abstract

Objective To assess the predictive value of endoscopic ultrasonography (EUS) for esophageal varices (EV) bleeding by studying the relationship between esophageal collateral veins (ECV), portal vein (PV) trunk with its main branches and EV bleeding. Methods A retrospective cohort study of 114 cases of moderate and severe EV was conducted. The ECV level was determined through EUS. At the same time, diameters of PV, azygos vein (AIV) and spleen vein (SV) were measured through EUS. The predictive value of ECV level and diameters of PV, AIV, SV for EV bleeding were assessed during the 1-year follow-up, which started from the first EUS examination to EV bleeding or the end of follow-up. Results Single factor Cox regression analysis showed severe peri-ECV varices had higher risk than mild in EV bleeding(HR=4.081, 95%CI: 1.833-9.086, P=0.001); severe para-ECV varices had higher risk than mild in EV bleeding(HR=4.042, 95%CI: 1.814-9.005, P=0.001). Multivariable Cox retrospective analysis showed ECV level was an effective predictor for EV bleeding, when the peri-ECV and para-ECV were severe varices, EV bleeding risk increased to 3.831 3 (P=0.004 3) and 3.493 3 (P=0.003 1) times compared with mild respectively. Diameters of PV, AIV and SV could predict EV bleeding(PV AUC=0.959, P 13.65 mm (sensitivity=0.94, specificity=0.84), AIV>8.65 mm (sensitivity=0.94, specificity=0.89), SV>9.45 mm (sensitivity=0.90, specificity=0.67), EV bleeding risk increased significantly. Conclusion EUS is helpful to predict the risk of moderate and severe EV bleeding, and severe varices of ECV, PV, AIV, and SV can be used as indicators to predict risk of EV bleeding. Key words: Ultrasonography; Esophageal and gastric varices; Hemorrhage; Portal hypertension