Delayed Argon Plasma Coagulation After Endoscopic Injection Sclerotherapy for Esophageal Varices Reduces Recurrence...

Area of Science:

• Gastroenterology
• Endoscopy
• Hepatology

Background:

• Esophageal varices (EVs) are a serious complication of portal hypertension.
• Argon plasma coagulation (APC) is a common consolidation therapy following endoscopic injection sclerotherapy (EIS) for EVs.
• The optimal timing for APC after EIS is not well-defined, impacting clinical outcomes.

Purpose of the Study:

• To evaluate the association between the interval from EIS to APC and clinical outcomes in patients with EVs.
• To determine if the timing of APC influences variceal recurrence, ulcer persistence, and adverse events.

Main Methods:

• A single-center retrospective cohort study included 112 patients undergoing EIS followed by APC for EVs.
• Patients were grouped into inpatient (shorter EIS-APC interval) or outpatient (longer EIS-APC interval) APC settings.
• Primary outcome was cumulative variceal recurrence analyzed by the Fine-Gray competing risk model; secondary outcomes included ulcer persistence and adverse events.

Main Results:

• The median EIS-APC interval was 7 days for inpatient APC and 28 days for outpatient APC.
• The cumulative 3-year variceal recurrence rate was significantly lower in the outpatient group (13.9%) compared to the inpatient group (28.0%).
• A longer EIS-APC interval was independently associated with reduced recurrence (aHR 0.92). Outpatient APC also showed less ulcer persistence, with comparable adverse events between groups.

Conclusions:

• A longer interval between EIS and APC is associated with a lower rate of esophageal variceal recurrence.
• Delaying APC until after mucosal healing may optimize treatment outcomes for EVs.
• The findings suggest that a longer EIS-APC interval is safe and effective in managing EVs.