Influence of high-risk esophageal varices on outcomes in hepatocellular carcinoma patients: benefits of prophylactic endoscopic therapies.

BACKGROUND/AIMS: To clarify whether high-risk esophageal varices (EVs) influence outcomes in hepatocellular carcinoma (HCC) patients and to determine whether prophylactic endoscopic therapies(PETs) provide benefits for such patients.

METHODOLOGY: Ninety-six consecutive patients with naive HCC complicated by EVs were analyzed. Patients with low-risk EVs (group A, n=53), those with high-risk EVs not treated with PETs (group B, n=31), and those with high-risk EVs treated with PETs (group C, n=12) were compared with respect to first bleeding and mortality. Furthermore, factors associated with outcomes were examined.

RESULTS: The first bleeding rates were higher in group B than in group A; the survival rates were lower in group B than in group A. High-risk EVs and advanced stage HCC were risk factors for both outcomes in groups A and B. By contrast, the first bleeding rates tended to be lower in group C than in group B, while the survival rates did not significantly differ. In groups B and C, advanced stage HCC was a risk factor for both outcomes, whereas PETs significantly decreased first bleeding.

CONCLUSIONS: High-risk EVs negatively influence both first bleeding and mortality in HCC patients and PETs may have a preventive effect on bleeding.