A retrospective study of endoscopic ultrasonography for predicting progression of esophageal varices in patients with hepatitis B virus-related hepatocirrhosis

Objective To assess the clinical value of endoscopic ultrasonography (EUS) for predicting esophageal varices (EV) progression in patients with hepatitis B virus (HBV)-related hepatocirrhosis. Methods A retrospective cohort study was performed on 299 HBV-related hepatocirrhosis patients with light EV in Tianjin Second People′s Hospital admitted from September 2014 to September 2015. The diameter and number of peri-esophageal collateral veins (ECV) and para-ECV were measured and described by EUS. The first EUS examination time was the starting point, and the follow-up of 24 months or EV progression was the end. Risk factors of EV progression were evaluated by multivariate Cox regression model, and the predictive value of EUS for EV progression was analyzed by receiver operating characteristic (ROC) curve. Results The cumulative incidence of EV progression was 2.3% (7/299), 14.8% (44/297), 33.7% (96/285) and 40.0% (120/273) at 6 months, 12 months, 18 months and 24 months of follow-up, respectively. The results of multivariate Cox regression analysis showed that the diameter of peri-ECV (P=0.011 2, HR=1.323 2, 95%CI: 1.065 6-1.642 9), the number of peri-ECV (P=0.000 1, HR=1.366 6, 95%CI: 1.163 4-1.605 2) and para-ECV diameter (P=0.000 2, HR=1.364 1, 95%CI: 1.155 8-1.610 0) were risk factors for EV progression. The use of nucleoside analogues treating HBV (P=0.002 0, HR=0.496 9, 95%CI: 0.318 6-0.775 1) and non-selective β-blockers descending portal venous pressure (P=0.076 5, HR=0.573 2, 95%CI: 0.309 7-1.061 1)were the protective factors for EV progression. The results of ROC curve analysis showed that the diameter of peri-ECV[P<0.001, area under the curve (AUC)=0.850, 95%CI: 0.804-0.895], the number of peri-ECV (P<0.001, AUC=0.831, 95%CI: 0.784-0.878), the diameter of para-ECV (P<0.001, AUC=0.924, 95%CI: 0.895-0.954), and the number of para-ECV (P<0.001, AUC=0.761, 95%CI: 0.704-0.817) had higher predictive value for EV progression; and the optimum cut-off values of each index were 1.85 mm, 3.5, 3.35 mm, and 4.5, respectively. The accuracies of prediction for EV progression were 76.60%, 75.19%, 84.48% and 70.29%, respectively. Conclusion EUS can be used to predict EV progression in HBV-related hepatocirrhosis patients. Peri-ECV diameter>1.85 mm, number>3.5, and para-ECV diameter>3.35 mm, number>4.5 suggest a high risk of EV progression. For patients with HBV-related hepatocirrhosis complicated with mild EV, nucleoside analogues to anti-HBV and non-selective β-blockers to reduce portal hypertension can prevent EV progression. Key words: Endoscopy, digestive system; Liver cirrhosis; Esophageal varices; Endoscopic ultrasonography; Predict