Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2021; 9(34): 10566-10575
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10566
Comparative study for predictability of type 1 gastric variceal rebleeding after endoscopic variceal ligation: High-frequency intraluminal ultrasound study
Jeong Hwan Kim, Won Hyeok Choe, Sun-Young Lee, So Young Kwon, In-Kyung Sung, Hyung Seok Park
Jeong Hwan Kim, Won Hyeok Choe, In-Kyung Sung, Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, South Korea
Sun-Young Lee, Department of Internal Medicine, Konkuk University Medical Center, Seoul 143729, South Korea
So Young Kwon, Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
Hyung Seok Park, Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul 05030, South Korea
Author contributions: Kim JH and Choe WH contributed to study conception and design; Kim JH, Choe WH, and Kwon SY contributed to collection of clinical data; Kim JH, Choe WH, Kwon SY, Lee SY, Sung IK, and Park HS contributed to data acquisition, data analysis, and interpretation; Kim JH, Choe WH, Kwon SY, Lee SY, Sung IK, and Park HS contributed to writing of the article, editing, reviewing, and final approval of the article.
Supported by Konkuk University Medical Center Research Grant 2018.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Konkuk University Hospital (KUH1010094).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained from the Electronic Medical Record of the Konkuk University Medical Center.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Won Hyeok Choe, MD, PhD, Professor, Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea. 20050101@kuh.ac.kr
Received: March 22, 2021
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
Research background

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.

Research motivation

The efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with EVL has not been established.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.