Correlation between angiographic features of esophageal varices and recurrence after endoscopic treatment

In spite of complete eradication of esophageal varices by endoscopic treatment, early recurrence or rebleeding is very common. Recurrence following endoscopic treatment for esophageal varices is considered to be affected by various clinical factors. However, it is unclear what parameters have significant impact on recurrence. We focused on angiographic features to investigate the correlation of the hemodynamic status to recurrence rate in esophageal varices.

Forty-five Japanese cirrhotic patients with risky esophageal varices were treated by Endoscopic Injection Sclerotherapy (EIS) after examination of selective left gastric arteriography or venography. We analyzed the correlation of the angiographic features before EIS and the cumulative recurrence rate using the log-rang test.

Features of the angiographies were classified into 2 types: Extending type (E-type): the image of the esophageal varices extended from the pericardiac venous plexus to the middle or upper esophagus; Disappearing type (D-type): the image disappeared in the portion of the abdominal esophagus. Of the 45 patients in this study, 20 (44.4%) fell into the E-type category and, 24 (53.3%) fell into the D-type category. The Cumulative variceal recurrence rate of the E-type was significantly lower than that of the D-type (log-rank test, p = 0.011). As regards background characteristics, no significant differences were found between the 2 groups.

Angiographic features classified into the E- and D-type categories by pre-treatment varicerography are a useful predictor of variceal recurrence after EIS.