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Prophylactic impact of endoscopic treatment for esophageal varices in liver resection: a prospective study

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 08 February 2014

Abstract

Background

Prophylactic treatment for esophageal varices has been performed without adequate supporting evidence. We assessed the feasibility of prophylactic and follow-up treatment for high-risk esophageal varices in patients with hepatocellular carcinoma (HCC).

Methods

Patients with HCC were screened prospectively and followed up for esophageal varices and gastroduodenal ulceration. High-risk esophageal varices (huge F3 varices or intermediate F2 varices positive for red color signs) were treated prophylactically. Follow-up endoscopy was performed to assess the impact of prophylaxis and changes in varices at 1 week, 1 month, and 6 months after operation. If high-risk varices were found during follow-up, secondary prophylaxis was performed according to the same criteria.

Results

Among 251 patients with HCC, 81 (32.3 %) had esophageal varices on screening endoscopy. Prophylactic endoscopic treatment was required by 13 patients (1 with F3 varices and 12 with F2 varices positive for red color signs). Ten varices worsened, and 4 varices progressed to high-risk varices requiring endoscopic treatment. No F0 or F1 varices at screening endoscopy progressed to high-risk varices, and no bleeding event occurred during 6 months of preplanned follow-up. A preoperative platelet count of less than 10 × 104/μL (odds ratio: 4.21, 95 % confidence interval 3.11–10.6; p < 0.001), the presence of splenomegaly (2.87, 2.16–21.8; p = 0.011), and an indocyanine green retention rate at 15 min of greater than 30 % (2.31, 1.88–24.6; p = 0.026) were independent predictors of worsening varices.

Conclusions

Our protocol for prophylactic and follow-up treatment of high-risk esophageal varices was feasible in patients with HCC.

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References

  1. Capussotti L, Ferrero A, Viganò L, et al. Portal hypertension: contraindication to liver surgery? World J Surg. 2006;30:992–9.

    Article  PubMed  Google Scholar 

  2. Ishizawa T, Hasegawa K, Aoki T, et al. Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology. 2008;134:1908–16.

    Article  PubMed  Google Scholar 

  3. Kawano Y, Sasaki A, Kai S, et al. Short- and long-term outcomes after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Ann Surg Oncol. 2008;15:1670–6.

    Article  PubMed  Google Scholar 

  4. Brocchi E, Caletti G, Brambilla G, et al. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. N Engl J Med. 1988;319:983–9.

    Article  Google Scholar 

  5. D’Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 2003;22:332–54.

    Google Scholar 

  6. de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005;43:167–76.

    Article  PubMed  Google Scholar 

  7. Bambha K, Kim WR, Pedersen R, et al. Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut. 2008;57:814–20.

    Article  CAS  PubMed  Google Scholar 

  8. Spina GP, Arcidiacono R, Bosch J, et al. Gastric endoscopic features in portal hypertension: final report of a consensus conference, Milan, Italy, September 19, 1992. J Hepatol. 1994;21:461–7.

    Article  CAS  PubMed  Google Scholar 

  9. del Olmo JA, Peña A, Serra MA, et al. Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis. J Hepatol. 2000;32:19–24.

    Article  PubMed  Google Scholar 

  10. Nidegger D, Ragot S, Berthelémy P, et al. Cirrhosis and bleeding: the need for very early management. J Hepatol. 2003;39:509–14.

    Article  PubMed  Google Scholar 

  11. Beppu K, Inokuchi K, Koyanagi N, et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc. 1981;27:213–8.

    Article  CAS  PubMed  Google Scholar 

  12. Merkel C, Zoli M, Siringo S, et al. Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenterol. 2000;95:2915–20.

    Article  CAS  PubMed  Google Scholar 

  13. Tomikawa M, Shimabukuro R, Okita K, et al. Propranolol alone may not be acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients: randomized controlled trial. J Gastroenterol Hepatol. 2004;19:576–81.

    Article  CAS  PubMed  Google Scholar 

  14. Carbonell N, Pauwels A, Serfaty L, et al. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40:652–9.

    Article  PubMed  Google Scholar 

  15. Snady H, Feinman L. Prediction of variceal hemorrhage: a prospective study. Am J Gastroenterol. 1988;83:519–25.

    CAS  PubMed  Google Scholar 

  16. Yeo W, Sung JY, Ward SC, et al. A prospective study of upper gastrointestinal hemorrhage in patients with hepatocellular carcinoma. Dig Dis Sci. 1995;40:2516–21.

    Article  CAS  PubMed  Google Scholar 

  17. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–38.

    Article  CAS  PubMed  Google Scholar 

  18. Chen WC, Hou MC, Lin HC, et al. Feasibility and potential benefit of maintenance endoscopic variceal ligation in patients with unresectable hepatocellular carcinoma and acute esophageal variceal hemorrhage: a controlled trial. Gastrointest Endosc. 2001;54:18–23.

    Article  CAS  PubMed  Google Scholar 

  19. Makuuchi M, Kosuge T, Takayama T, et al. Surgery for small liver cancers. Semin Surg Oncol. 1993;9:298–304.

    Article  CAS  PubMed  Google Scholar 

  20. Takayama T, Makuuchi M, Kubota K, et al. Randomized comparison of ultrasonic vs clamp transection of the liver. Arch Surg. 2001;136:922–8.

    Article  CAS  PubMed  Google Scholar 

  21. Chalasani N, Kahi C, Francois F, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol. 2003;98:653–9.

    Article  PubMed  Google Scholar 

  22. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology. 2001;33:802–7.

    Article  CAS  PubMed  Google Scholar 

  23. Bruix J, Castells A, Bosch J, et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology. 1996;111:1018–22.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the grant from 2013 Hagiwara fund, Nihon University School of Medicine.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan

    Shintaro Yamazaki, Tadatoshi Takayama, Masahiko Nakamura & Tokio Higaki

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan

    Shunichi Matsuoka, Shigeaki Mizuno & Mitsuhiko Moriyama

Authors
  1. Shintaro Yamazaki
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  2. Tadatoshi Takayama
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  3. Masahiko Nakamura
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  4. Tokio Higaki
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  5. Shunichi Matsuoka
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  6. Shigeaki Mizuno
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  7. Mitsuhiko Moriyama
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Correspondence to Shintaro Yamazaki.

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Yamazaki, S., Takayama, T., Nakamura, M. et al. Prophylactic impact of endoscopic treatment for esophageal varices in liver resection: a prospective study. J Gastroenterol 49, 917–922 (2014). https://doi.org/10.1007/s00535-013-0841-y

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  • DOI: https://doi.org/10.1007/s00535-013-0841-y

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