+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

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.

Please choose payment method:

(PDF emailed within 1 workday: $29.90)

Accession: 035026127

Download citation: RISBibTeXText

Related references

Recurrence of esophageal varices following endoscopic treatment and its impact on rebleeding: Comparison of sclerotherapy and ligation. Journal of Hepatology 32(2): 202-208, 2000

Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices. World Journal of Gastroenterology 22(11): 3212-3219, 2017

Clinical trial: a randomized controlled study on prevention of variceal rebleeding comparing nadolol + ligation vs. hepatic venous pressure gradient-guided pharmacological therapy. Alimentary Pharmacology and Therapeutics 29(4): 397-408, 2008

Endoscopic ultrasound findings predict the recurrence of esophageal varices after endoscopic band ligation: a prospective cohort study. Scandinavian Journal of Gastroenterology 50(11): 1322-1330, 2016

Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: Influence on gastropathy, gastric varices and variceal recurrence. Journal of Hepatology 26(4): 826-832, 1997

Relationships between the time-course of hepatic venous pressure gradient and the response to endoscopic treatment of varices in cirrhotic patients with acute variceal bleeding. Hepatology 34(4 Pt 2): 535A, 2001

Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage. Endoscopy International Open 3(5): E523-E528, 2015

Clinical trial: The effect of somatostatin vs. octreotide in preventing post-endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices. Alimentary Pharmacology and Therapeutics 26(11-12): 1479-1487, 2007

Clinical application of hepatic venous pressure gradient to predict early bleeding after esophageal variceal ligation. Zhonghua Gan Zang Bing Za Zhi 23(1): 50-54, 2015

Incidence and predictors of rebleeding after band ligation of oesophageal varices. Arab Journal of Gastroenterology 15(3-4): 135-141, 2016

Propranolol associated with endoscopic band ligation reduces recurrence of esophageal varices for primary prophylaxis of variceal bleeding: a randomized-controlled trial. European Journal of Gastroenterology and Hepatology 27(1): 84-90, 2015

Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? No. European Journal of Internal Medicine 22(1): 5-7, 2011

Hepatic venous pressure gradient is a useful predictor in guiding treatment on prevention of variceal rebleeding in cirrhosis. International Journal of Clinical and Experimental Medicine 8(10): 19709-19716, 2016