Perforating Veins Detected by Endoscopic Ultrasonography Are Useful in Predicting the Recurrence of Esophageal Varices After Endoscopic Variceal Ligation Combined With Argon Plasma Coagulation.

OBJECTIVES

Few attempts have been made to determine the risk factors for the recurrence of esophageal varices (EV) and the optimal surveillance interval. This study analyzed whether endoscopic ultrasonography can be used to predict EV recurrence and determine the optimal timing for surveillance endoscopy post-treatment.

METHODS

We retrospectively evaluated patients with EVs who underwent endoscopic variceal ligation (EVL) combined with argon plasma coagulation (APC), followed by endoscopic ultrasonography (EUS) using a miniature ultrasonic probe 1 month after APC. Factors associated with EV recurrence were assessed using the Fine-Gray competing risk regression model, with death considered as the competing risk. The cumulative incidence of EV recurrence was estimated using the cumulative incidence function, and groups were compared using Gray's test.

RESULTS

Of 163 eligible patients, 37 (23%) experienced EV recurrence during a median follow-up period of 36 months (interquartile range: 15-76 months). Multivariable analysis revealed that the presence of perforating veins (PVs) was a significant factor for EV recurrence (sub-distribution hazard ratio, 4.30; 95% confidence interval, 2.13-8.71; p < 0.001). The cumulative incidence of EV recurrence was significantly higher in patients with PV than in those without (6-month and 1-year recurrence rates: 27.3% and 41.6% vs. 3.9% and 5.5%, respectively; p < 0.001).

CONCLUSIONS

PVs detected using EUS independently predict EV recurrence risk after EVL combined with APC. Given that patients with PVs experience a high recurrence rate within 6 months, comprehensive surveillance endoscopy at 6-month intervals is recommended in the first year post-treatment.