Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10566
Peer-review started: March 22, 2021
First decision: April 29, 2021
Revised: May 31, 2021
Accepted: October 15, 2021
Article in press: October 15, 2021
Published online: December 6, 2021
After successful control of acute bleeding with emergency endoscopic variceal ligation (EVL), endoscopic follow-up should be repeated, and residual or recurrent varices should be treated with elective EVL to prevent variceal rebleeding if indicated. Recently, endoscopic ultrasound (EUS) has been introduced as an important modality in the diagnosis of varices, because EUS is more sensitive than esophagogastroduodenoscopy (EGD) for the evaluation of gastric varices.
The efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with EVL has not been established.
This study aimed to evaluate the diagnostic correlation of EGD and high-frequency intraluminal ultrasound (HFIUS) for type 1 gastric varices (GOV1) after EVL and to identify the predictability for rebleeding with EGD and HFIUS.
In liver cirrhosis patients with GOV1, we performed endoscopic follow-up using EGD and HFIUS synchronously after EVL for hemorrhage from GOV1. Endoscopic grading and red color signs were analyzed using EGD, and the largest variceal cross-sectional areas (CSAs) were measured using HFIUS. In addition, 1-year follow-up was performed. Variceal rebleeding was defined as the presence of hematemesis, hematochezia or melena without other evidence of bleeding on endoscopic follow-up.
In 26 patients with GOV1, variceal CSA on HFIUS of GOV1 was poorly correlated with EGD grading of GOV1 (r = 0.36). In 17 patients who completed the 1-year follow-up, variceal CSA on HFIUS was a good predictor of subsequent rebleeding, whereas EGD grading was not a predictor of subsequent rebleeding.
HFIUS measurement is more predictive of GOV1 rebleeding than EGD grading, so HFIUS measurement may be necessary for endoscopic follow-up after EVL in patients with GOV1.
Future work and basic research should be performed to confirm that EUS, especially HFIUS, could be performed to estimate the accurate variceal size and predict rebleeding of GOV1.