Incidence of the appearance of the red color sign on esophageal varices and its predictive factors: long-term observations of 359 patients with cirrhosis

Abstract

Endoscopic signs of esophageal varices and platelet count were significant predictors for the appearance of the red color sign.

Endoscopic injection sclerotherapy for esophageal varices in cirrhotic patients without hepatocellular carcinoma: a comparison of longterm survival between prophylactic therapy and emergency therapy

“…1-3 Endoscopic control of variceal bleeding (such as EIS and EVL) in liver cirrhosis has been a controversial clinical treatment under investigation for many years, and several attempts have been made to evaluate the efficacy of endoscopic therapy for esophageal varices in liver cirrhosis patients. [4][5][6][7][8][9][10][11][12][13][14][15][16][17]20 We previously showed that EIS prolonged survival in patients with esophageal varices complicated by liver cirrhosis with HCC, and that emergency and/or prophylactic EIS was effective in prolonging the survival period of HCC patients. 9,21,22 Miyoshi et al 23 showed that prophylactic EIS improved survival in HCC patients with liver cirrhosis compared with survival in those without EIS.…”

“…[1][2][3] Endoscopic therapies for esophageal varices, such as endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL), have improved the overall management of variceal hemorrhage, [4][5][6][7][8] and we have demonstrated that EIS is effective in prolonging the survival period of patients complicated by liver cirrhosis with hepatocellular carcinoma (HCC). 9 Prophylactic endoscopic treatment for high-risk esophageal varices has been widely performed in Japan, 6,[10][11][12][13][14][15][16][17] although the efficacy of prophylactic endoscopic treatment for esophageal varices is still controversial in other countries, including Western countries. 18,19 The aim of this study was to evaluate whether the application of prophylactic EIS for esophageal varices for patients complicated by liver cirrhosis is more beneficial compared with the application of emergency EIS.…”

Clinical implications of the red color sign on esophageal varices

“…However, the value of these factors as a risk index for imminent bleeding is lower than that of endoscopic findings. In this issue of the Journal of Gastroenterology, Murashima et al 12 demonstrate a correlation between the RC and the size and number of esophageal varices, as well as a correlation between the RC and a platelet count of less than 100 000/µl, indicating that these are significant predictive factors for the appearance of the RC. Their report also states that an endoscopic examination is required once every 5 years for patients without esophageal varices, once every year for patients with F1 varices, and once every given interval shorter than a year if there are more than three F2 varices.…”

“…Their report also states that an endoscopic examination is required once every 5 years for patients without esophageal varices, once every year for patients with F1 varices, and once every given interval shorter than a year if there are more than three F2 varices. Murashima et al 12 suggest, further, that for any of the aforementioned patients, if the platelet count is less than 100 000/µl, the intervals between follow-up endoscopic examinations need to be shorter. Although the goal of endoscopic follow-up is to know when to start the treatment, the clinical implications of the detection of the appearance of RC are not dealt with in this study.…”

“…Diagnosis can easily include some bias if the endoscopist who knows the patient's data performs the examination. Accordingly, the article by Murashima et al 12 should have included information regarding who the observer was, whether the study was blind regarding the patients' details, and whether there were single or multiple observers. In addition, intra-observer and/or interobserver agreement should have been shown.…”