Prediction of Variceal Recurrence After Eradication: Comparison of Ten Non-Invasive Tests Performance

Aims Acute variceal bleeding(AVB) is a life-threatening complication of portal hypertension. its management is essentially based on endoscopic variceal ligation(EVL). Nevertheless, even after eradication of esophageal varices(EV), the risk of recurrence and therefore re-bleeding persists. Our objective was to compare the performance of ten non-invasive liver function tests in the prediction of variceal-recurrence(VR) after EV eradication in cirrhotic patients.

Methods This is a retrospective study including, between January 2010 and December 2019, all cirrhotic patients who benefited from EV eradication and a follow-up of more than 6months. VR was defined as the development of AVB or an increase in EVs size to ≥grade1. The following scores were calculated at the first EVL: APRI, FIB-4, albumin-bilirubin grade(ALBI), platelet-albumin-bilirubin grade(PALBI), king’s score, aspartate-aminotransferase to alanine-aminotransferase ratio(AAR), Lok index, Cirrhosis-Discriminant Score(CDS), Goteborg-University Cirrhosis Index(Guci) and age to platelet index.

Results A total of 219 patients were included. Seventy-nine patients benefited from EV eradication(36 %). It was for primary prophylaxis in 8.86 % and for secondary prophylaxis in 91.14 %. The sex-ratio was 1.63 and the mean age was 62.3±13.4. The main etiology of cirrhosis was viral infection(53,9 %) followed by non-alcoholic-steatohepatitis(13.3 %). VR occurred in 15.2 % of cases. Among the calculated scores, FIB-4(p = 0,01) and king’s score(p = 0,04) were statistically correlated with VR. In univariate analysis, in addition to FIB-4 and King’s score, smoking(p = 0,03) and excessive alcohol consumption(p = 0,04) were also associated with VR. In multivariate analysis, FIB-4 was the only non-invasive score independent factor associated with VR. The area under the ROC curve of FIB-4 was 0.697 [95 %CI; 0,557-0,83]. At the cut-off of 5,71, FIB-4 had a sensibility and specificity of 75 % and 61 %, respectively, in VR prediction after EV eradication.

Conclusions In our study, FIB-4 was the best non-invasive score in VR prediction after EV eradication. This score would be useful to identify vulnerable patients who would require close monitoring.

Citation: Trad N, Ghanem M, Ben slimen B et al. eP51 PREDICTION OF VARICEAL RECURRENCE AFTER ERADICATION: COMPARISON OF TEN NON-INVASIVE TESTS PERFORMANCE. Endoscopy 2021; 53: S113.

Publication History

Article published online:
19 March 2021