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Hepatic venous pressure gradient predicts early recurrence of varices and rebleeding after endoscopic band ligation



Hepatic venous pressure gradient predicts early recurrence of varices and rebleeding after endoscopic band ligation



Hepatology 38(4 Suppl 1): 295A



Endoscopic band ligation (EBL) is widely used to prevent esophageal variceal rebleeding. Patients on EBL require an intensive follow-up, since early recurrence of varices is common. An increased portal pressure is the driving force for variceal formation. However, the influence of portal pressure on prediction of recurrence of varices after initial obliteration by EBL has not yet been considered. The present study aimed to investigate whether portal pressure measurement and endoscopic ultrasound can predict the recurrence of esophageal varices after EBL. Thirty-three patients with bleeding esophageal varices received repeated sessions of EBL at 2-week intervals until all varices were obliterated or up to 5 sessions. The size and number of paraesophageal varices (PEV) by endoscopic ultrasound and HVPG were measured before and after variceal obliteration by EBL. Endoscopic follow-up was performed at 3, 6 and 12 months after variceal obliteration. The primary end-point of the study was failure of treatment, defined as early (<6 months) variceal rebleeding, early (<6 months) variceal recurrence or lack of variceal obliteration after 5 sessions of banding. Results: Failure of treatment occurred in 21 (64%) patients: early rebleeding in 5 cases, early recurrence in 14 cases and lack of obliteration in 2 cases. The HVPG was greater in patients with failure of treatment: 22.5 (5.4) vs. 17.7 (4.2) mmHg (p<0.05). Probability of treatment failure was greater in patients with an HVPG>20 mmHg (12, 35, 71% vs. 7, 13, 33 at 1, 3 and 6 months, respectively; p=0.01). HVPG, and size and number of PEV were associated to treatment failure in the univariate analysis. In multivariate analysis, HVPG was the only independent predictor of treatment failure (RR: 3.1, CI 95% 1.2-8.8). HVPG did not change after EBL, 20.7 (5.2) vs. 20.9 (5.7) mmHg. Variceal rebleeding appeared in 7 cases (21%), in 5 patients within 6 months and in 2 patients thereafter. Recurrence of varices occurred after a mean time of 160 days (CI 95%: 107-213), in 14 patients before and in 2 patients after 6 months. Conclusion: An HVPG>20 mmHg identifies patients with a high probability of early recurrence or rebleeding of esophageal varices after EBL. Measurement of HVPG before EBL selects subjects that could benefit of concomitant or alternative pharmacologic therapy.

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