The efficacy of contrast-enhanced computed tomography on the management of gastroesophageal varices in patients with hepatocellular carcinoma

Abstract

The screening of gastroesophageal varices (GEV) is critical in hepatocellular carcinoma (HCC) management. Contrast-enhanced computed tomography (CECT) is often performed in patients with HCC. Therefore, this study aimed to examine the use of CECT in screening for GEV and predicting GEV bleeding. This retrospective study enrolled 312 consecutive patients who are initially diagnosed with HCC, measured the lower esophageal (EIV) and fundal intramural vessel (FIV) diameter on CECT, examined the changes after 1, 2, and 3 years, and verified the relationship with GEV bleeding. The EIV and FIV diameter on CECT correlates well with endoscopic variceal classification. EIV significantly worsened after 2 and 3 years. FIV showed worsening at both 1, 2, and 3 years. Cumulative GEV bleeding rates were 3.7% at 1 year and 6.2% at 3 years. The multivariate analysis revealed that EIV, FIV, and portal vein tumor thrombus were associated with GEV bleeding. Furthermore, EIV deterioration at 1, 2, and 3 years correlated with GEV bleeding. In conclusion, CECT is useful in variceal management during the longitudinal clinical course of HCC, and has the potential to decrease screening endoscopy. With deterioration in EIV, treatments should be considered due to a high-risk GEV bleeding.

Clinical risk factors for portal hypertension-related complications in systemic therapy for hepatocellular carcinoma

“…The gold standard for EV screening is endoscopy. However, as our previous and present reports have revealed, CECT has the potential of usefulness in variceal evaluation during systemic therapy for HCC [ 15 ]. Furthermore, the portosystemic shunt, a factor in the incidence of HE, can be identified using CECT prior to systemic therapy.…”

“…Additionally, other studies have reported the efficacy of CECT in evaluating portosystemic shunts [ 14 ]. We previously reported the usefulness of CECT in the management of EV in patients with HCC [ 15 ]. However, further validation is required in patients with HCC undergoing systemic therapy.…”