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Eradication of esophageal varices by sclerotherapy combined with argon plasma coagulation: Effect of portal hemodynamics and longitudinal clinical course
Author(s) -
Kondo Takayuki,
Maruyama Hitoshi,
Kiyono Soichiro,
Sekimoto Tadashi,
Shimada Taro,
Takahashi Masanori,
Okugawa Hidehiro,
Yokosuka Osamu,
Kawahira Hiroshi,
Yamaguchi Tadashi
Publication year - 2016
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12562
Subject(s) - medicine , argon plasma coagulation , esophageal varices , gastroenterology , portal venous pressure , sclerotherapy , cirrhosis , hazard ratio , hemodynamics , portal hypertension , portal vein thrombosis , confidence interval , surgery , endoscopy
Background and Aim To demonstrate the effect of endoscopic injection sclerotherapy (EIS) with argon plasma coagulation (APC) as a primary/secondary prophylaxis for esophageal varies (EV) on portal hemodynamics and long‐term outcomes in cirrhosis. Methods This prospective study included 48 cirrhotic patients (64.5 ± 11.4 years; 26 bleeders, 22 non‐bleeders). Post‐treatment outcomes (EIS and APC; median observation period, 12.8 months for recurrence and 21.1 months for prognosis) were evaluated with respect to the findings of hepatic venous catheterization, Doppler ultrasound, and endoscopic ultrasonography (EUS). Results All patients showed EV eradication after endoscopic treatment, and a decreased frequency of a patent left gastric vein (pre: 83.3%, post: 27.1%, P < 0.001). However, hepatic venous pressure gradient (HVPG, mmHg) remained unchanged after the treatment, pre: 16.1 ± 3.6, post: 15.6 ± 3.8 ( P = 0.269). Cumulative variceal recurrence/rebleeding rates were 25.5%/5.6% and 62.4%/23.1% at 1 and 3 years, respectively. Post‐treatment EUS finding, area of submucosal vessels in the cardia ≥12 mm 2 was the only significant factor for variceal recurrence (hazard ratio 9.769, 95% confidence interval 3.046–31.337; P < 0.001). Cumulative recurrence rate was significantly higher in patients with area of submucosal vessels in the cardia ≥12 mm 2 (58.3% at 1 year and 100% at 3 years) than in those without (11.4% at 1 year and 40.9% at 3 years, P < 0.001). Cumulative overall survival rates were 95.2% and 71.9% at 1 and 3 years, respectively, showing no significant relationship with HVPG. Conclusion EIS with APC for EV is unlikely to have a significant influence on portal pressure.