Esophageal collateral veins in predicting esophageal variceal recurrence and rebleeding after endoscopic treatment:a systematic review and meta-analysis

Background:Endoscopic treatment is recommended for the management of esophageal varices.However,variceal recurrence or rebleeding is common after endoscopic variceal eradication.Our study aimed to systematically evaluate the prevalence of esophageal collateral veins(ECVs)and the association of ECVs with recurrence of esophageal varices or rebleeding from esophageal varices after endoscopic treatment.Methods:We searched the relevant literature through the PubMed,EMBASE,and Cochrane Library databases.Prevalence of paraesophageal veins(para-EVs),periesophageal veins(peri-EVs),and perforating veins(PVs)were pooled.Risk ratio(RR)and odds ratio(OR)with 95%confidence intervals(CIs)were calculated for cohort studies and case-control studies,respectively.A random-effects model was employed.Heterogeneity among studies was calculated.Results:Among the 532 retrieved papers,28 were included.The pooled prevalence of para-EVs,peri-EVs,and PVs in patients with esophageal varices was 73%,88%,and 54%,respectively.The pooled prevalence of para-EVs and PVs in patients with recurrence of esophageal varices was 87%and 62%,respectively.The risk for recurrence of esophageal varices was significantly increased in patients with PVs(OR=9.79,95%CI:1.95-49.22,P=0.006 for eight case-control studies),but not in those with para-EVs(OR=4.26,95%CI:0.38-38.35,P=0.24 for four case-control studies;RR=1.81,95%CI:0.83-3.97,P=0.14 for three cohort studies).Patients with para-EVs had a significantly higher incidence of rebleeding from esophageal varices(RR=13.00,95%CI:2.43-69.56,P=0.003 for two cohort studies).Statistically significant heterogeneity was notable across the meta-analyses.Conclusions:ECVs are common in patients with esophageal varices.Identification of ECVs could be helpful for predicting the recurrence of esophageal varices or rebleeding from esophageal varices after endoscopic treatment.

Impact of endoscopic ultrasound examination for deep esophageal collateral veins evaluation in liver cirrhosis patients prior to endoscopic treatment:A case series

Aim:The presence of esophageal collateral veins(ECV)has been reported to be associated with the recurrence of esophageal varices(EV)and bleeding in liver cirrhotic(LC)patients.This study aimed to see the potential clinical value of deep collateral veins assessment using endoscopic ultrasound(EUS)in liver cirrhotic patients with EV.Methods:During 6 months period,a prospective study is conducted,where we identified LC patients who were admitted for esophagogastroduodenoscopy(EGD)screening at the Department of Internal Medicine,Dr.Cipto Mangunkusumo National General Hospital,Jakarta.ECV was examined using EUS.Patients were excluded if they had(1)liver malignancy,(2)history of ligation or glue injection,or(3)portal or splenic vein thrombus.We collected demographic data,medical history,data pertaining to use of nonselective beta blocker(NSBB),and laboratory,imaging,and endoscopy results.EGD was performed using a gastroscope(EG29‐i10,3.2 mm Pentax Medical)while EUS was performed using a linear array echoendoscope(EG‐3870UTK,3.8 mm,Pentax Medical)before band ligation or glue injection.Results:There were 20 LC patients included in this study,where 15(75%)of patients were classified with Child-Pugh(CP)‐A and five(25%)of patients with CP‐B.The most common aetiologies were hepatitis B in seven(35%)patients and hepatitis C in nine(45%)patients.The EV with peri‐or para‐esophageal veins(PEEV or PAEV)were detected in 65%of patients.None of the LC patients with no EV showed the presence of ECV.PEEV or PAEV were detected in grades 1-3 EV.Conclusion:EUS examination can give a better evaluation before managing gastroesophageal varices through deep ECV detection in LC patients.