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Influence of gastroesophageal flap valve on esophageal variceal bleeding in patients with liver cirrhosis
Author(s) -
Koya Yudai,
Shibata Michihiko,
Watanabe Tatsuyuki,
Kumei Shinsuke,
Miyagawa Koichiro,
Oe Shinji,
Honma Yuichi,
Kume Keiichiro,
Yoshikawa Ichiro,
Harada Masaru
Publication year - 2021
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.13685
Subject(s) - medicine , esophageal varices , gastroenterology , clinical endpoint , cumulative incidence , hazard ratio , cirrhosis , confidence interval , propensity score matching , incidence (geometry) , proportional hazards model , surgery , cohort , portal hypertension , randomized controlled trial , physics , optics
Objectives Esophageal variceal bleeding can be fatal in patients with liver cirrhosis. The aim of this study was to investigate the relationship between gastroesophageal flap valve (GEFV) and esophageal variceal bleeding. Methods Subjects were cirrhotic patients with endoscopically diagnosed esophageal varices treated at our hospital between 2005 and 2019, excluding those with F3 form and red color (RC) signs at first endoscopy. Sixty‐five patients with normal GEFV (Hill grade I or II) and 42 with abnormal GEFV (Hill grade III or IV) were enrolled. Propensity score matching eliminated the baseline differences, resulting in a sample size of 30 patients per cohort. The primary endpoint was esophageal variceal bleeding, and the secondary endpoint was variceal bleeding or appearance of RC sign. We analyzed the cumulative incidences and predictors of each endpoint. Results The 3‐, 5‐, and 10‐year cumulative incidences of the primary endpoints were all 3.4% in the normal GEFV group, and 19.0%, 24.6% and 34.0% in the abnormal GEFV group, respectively (log‐rank P = 0.011). Cumulative incidence of the secondary endpoint was 13.8%, 33.1% and 39.2% in the normal GEFV group, and 42.2%, 54.6% and 84.9% in the abnormal GEFV group, respectively (log‐rank P = 0.001). In multivariate Cox regression analyses, hazard ratios of abnormal GEFV of the primary and secondary endpoints were 12.79 (95% confidence interval 1.331–122.8) and 3.600 (1.653–7.840), respectively. Conclusions Abnormal GEFV was an independent risk factor for esophageal variceal bleeding and appearance of RC sign.