The Risk of Bleeding in Small/Straight Esophageal Varices with Red Color Sign on Endoscopy: A Retrospective Analysis...

Area of Science:

• Gastroenterology
• Hepatology
• Endoscopic interventions

Background:

• Red color sign-positive (RC-positive) esophageal varices carry a high bleeding risk.
• Small straight varices (Form level 1: F1) that are RC-positive pose treatment challenges.
• Optimal timing for therapeutic intervention in these varices is not well-defined.

Purpose of the Study:

• To assess the bleeding risk associated with RC-positive F1 esophageal varices.
• To compare bleeding rates between immediate treatment and follow-up strategies.
• To identify factors contributing to bleeding and early bleeding in these varices.

Main Methods:

• Retrospective analysis of 541 F1 esophageal varices cases diagnosed between January 2012 and February 2020.
• Focus on 76 RC-positive F1 esophageal varices, divided into a treatment group (49 cases) and a follow-up group (27 cases).
• Evaluation of bleeding rates, bleeding-associated factors, and early-bleeding factors.

Main Results:

• The treatment group had a significantly lower bleeding rate (10%) compared to the follow-up group (78%).
• The median period of sustained absence of bleeding was substantially longer in the treatment group.
• Hematocystic spots (HCS) were significantly associated with bleeding and early bleeding in the follow-up group.

Conclusions:

• RC-positive F1 esophageal varices warrant prophylactic treatment, regardless of their size.
• Patients with only red wale marking (RWM) may not require immediate intervention.
• Prompt management is critical for HCS-positive varices due to high bleeding risk.