Abstract
Background
Endoscopic treatment is widely performed for esophageal varices, but prediction of post-treatment recurrence is difficult.
Methods
The subjects were 298 patients with cirrhosis who underwent initial endoscopic treatment for esophageal varices from January 1997 to December 2010 and were followed-up at our hospital. The average age was 64.5 years (29–84) and the male/female ratio was 119:89. The causes of cirrhosis were hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholism, non-alcoholic steatohepatitis (NASH), and others in 66, 14, 13, 3 and 4% of the subjects, respectively. Hepatic reserve capacity before treatment was Child-Pugh score 6.9 ± 1.5 points, albumin 3.2 ± 0.6 g/dl, total bilirubin 1.4 ± 0.7 mg/dl, and PT% 71.0 ± 13.8%. Complication of hepatocellular cancer (HCC) was present in 63 subjects (30.4%). Treatment-indicated recurrence was defined as ³F2 and ³RC2. Recurrence occurred in 102 subjects, including 65 who redeveloped varicosity within 1 year. Data were compared between patients with (n = 65) and without (n = 43) early recurrence (within 1 year).
Results
The early recurrence group had a significantly higher Child-Pugh score (7.4 ± 1.8 vs. 6.7 ± 1.3, P < 0.01), total bilirubin (1.6 ± 0.8 vs. 1.2 ± 0.6 mg/dl, P < 0.01), and HCC complication rate (44.6% vs. 23.9%, P < 0.01), and significantly lower albumin (3.0 ± 0.7 vs. 3.3 ± 0.6 g/dl, P < 0.01) and administration rate of antihypertensive drugs (10.8% vs. 41.0%, P < 0.01). In multivariate logistic regression analysis, use of antihypertensive drugs, total bilirubin, HCC, underlying disease (alcoholism), and treatment method (endoscopic injection sclerotherapy [EIS] or endoscopic variceal ligation [EVL]) emerged as factors that affected early recurrence. Based on these findings, we developed the following predictive equation: recurrence time (months) = - 12.5206 (HCC: confirmed = 1, not confirmed = 0) - 3.5029 (total bilirubin) + 6.2169 (antihypertensive drug: used = 1, not used = 0) - 7.2581 (alcoholism: yes = 1, no = 0) - 6.0764 (EVL = 1, EIS = 0) + 35.7165. Based on this formula, we examined the predicted and actual recurrence times in 68 subjects from January 2011 to December 2012 and found a significant positive correlation between these data (R = 0.583, P < 0.01).
Conclusion
An equation was developed for prediction of recurrence of esophageal varices after treatment and was shown to have utility in actual cases.
Disclosure
All authors have declared no conflicts of interest.