Useful Endoscopic Ultrasonography Parameters and a Predictive Model for the Recurrence of Esophageal Varices and Bleeding after Variceal Ligation
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: To identify the usefulness of endoscopic ultrasonography with a mini-probe (EUM) and to create a predictive model for esophageal variceal (EV) recurrence and bleeding following esophageal variceal ligation (EVL). Methods: A total of 144 patients who received EUM prior to prophylactic EVL and met the inclusion criteria were enrolled. EUM findings, EV diameter, paraesophageal vein diameter, and the number of perforating veins were assessed. Results: EV recurrence was observed in 42 patients (29.2%), 10 of whom experienced EV bleeding. Larger diameter of the paraesophageal vein (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.17 to 1.96; p=0.002) and perforating vein (OR, 3.27; 95% CI, 1.11 to 9.65; p=0.032) were significant predictive factors for EV recurrence. However, the diameter of the paraesophageal vein was the only significant risk factor for EV bleeding (adjusted OR, 1.51; 95% CI, 1.06 to 2.16; p=0.022). The areas under the curves of the predictive model for EV recurrence and bleeding were 0.872 (95% CI, 0.811 to 0.934) and 0.811 (95% CI, 0.630 to 0.992), respectively. Conclusions: The diameter of the paraesophageal vein was a significant predictive factor for EV recurrence and bleeding. The predictive model constructed based on the significant EUM findings exhibited good performance.
Abstract
Background/Aims: To identify the usefulness of endoscopic ultrasonography with a mini-probe (EUM) and to create a predictive model for esophageal variceal (EV) recurrence and bleeding following esophageal variceal ligation (EVL). Methods: A total of 144 patients who received EUM prior to prophylactic EVL and met the inclusion criteria were enrolled. EUM findings, EV diameter, paraesophageal vein diameter, and the number of perforating veins were assessed. Results: EV recurrence was observed in 42 patients (29.2%), 10 of whom experienced EV bleeding. Larger diameter of the paraesophageal vein (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.17 to 1.96; p=0.002) and perforating vein (OR, 3.27; 95% CI, 1.11 to 9.65; p=0.032) were significant predictive factors for EV recurrence. However, the diameter of the paraesophageal vein was the only significant risk factor for EV bleeding (adjusted OR, 1.51; 95% CI, 1.06 to 2.16; p=0.022). The areas under the curves of the predictive model for EV recurrence and bleeding were 0.872 (95% CI, 0.811 to 0.934) and 0.811 (95% CI, 0.630 to 0.992), respectively. Conclusions: The diameter of the paraesophageal vein was a significant predictive factor for EV recurrence and bleeding. The predictive model constructed based on the significant EUM findings exhibited good performance.
참고문헌 (20)
- Garcia-Tsao G, "Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis", Hepatology, 46, pp.922~938 (2007)
- North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices, "Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study", N Engl J Med, 319, pp.983~989 (1988)
- Suk KT, "Revision and update on clinical practice guideline for liver cirrhosis", Korean J Hepatol, 18, pp.1~21 (2012)
- D’Amico G, "Cooperative Study Group. Upper digestive bleeding in cirrhosis: post-therapeutic outcome and prognostic indicators", Hepatology, 38, pp.599~612 (2003)
- de Franchis R, "Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension", J Hepatol, 53, pp.762~768 (2010)
- Kitano S, "Venous anatomy of the lower oesophagus in portal hypertension: practical implications", Br J Surg, 73, pp.525~531 (1986)
- Hashizume M, "Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension", Hepatology, 8, pp.1482~1487 (1988)
- Sgouros SN, "Endoscopic ultrasonography in the diagnosis and management of portal hypertension", Where are we next? Dig Liver Dis, 38, pp.289~295 (2006)
- Leung VK, "Large paraesophageal varices on endosonography predict recurrence of esophageal varices and rebleeding", Gastroenterology, 112, pp.1811~1816 (1997)
- Tajiri T, "General rules for recording endoscopic findings of esophagogastric varices (2nd edition)", Dig Endosc, 22, pp.1~9 (2010)
- de Franchis R, "Evolving consensus in portal hypertension: report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension", J Hepatol, 43, pp.167~176 (2005)
- Venables WN, "Modern applied statistics with S" (2002), Springer-Verlag
- Fox J, "Generalized collinearity diagnostics", J Am Stat Assoc, 87, pp.178~183 (1992)
- Youden WJ, "Index for rating diagnostic tests", Cancer, 3, pp.32~35 (1950)
- de Paulo GA, "Treatment of esophageal varices: a randomized controlled trial comparing endoscopic sclerotherapy and EUS-guided sclerotherapy of esophageal collateral veins", Gastrointest Endosc, 63, pp.396~402 (2006)
- Sarin SK, "Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence", J Hepatol, 26, pp.826~832 (1997)
- Hou MC, "Recurrence of esophageal varices following endoscopic treatment and its impact on rebleeding: comparison of sclerotherapy and ligation", J Hepatol, 32, pp.202~208 (2000)
- Lo GH, "Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy", Gastrointest Endosc, 49(4 Pt 1), pp.428~436 (1999)
- Konishi Y, "Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence", Gastrointest Endosc, 55, pp.197~203 (2002)
- Masalaite L, "Endoscopic ultrasound findings predict the recurrence of esophageal varices after endoscopic band ligation: a prospective cohort study", Scand J Gastroenterol, 50, pp.1322~1330 (2015)
