Association of endoscopic variceal treatment with portal venous system thrombosis in liver cirrhosis: a case-control study

Le Wang; Xiaozhong Guo; Xiaodong Shao; Xiangbo Xu; Kexin Zheng; Ran Wang; Saurabh Chawla; Metin Basaranoglu; Xingshun Qi

doi:10.1177/17562848221087536

Association of endoscopic variceal treatment with portal venous system thrombosis in liver cirrhosis: a case-control study

Therap Adv Gastroenterol. 2022 May 11:15:17562848221087536. doi: 10.1177/17562848221087536. eCollection 2022.

Authors

Le Wang¹, Xiaozhong Guo¹, Xiaodong Shao¹, Xiangbo Xu¹, Kexin Zheng¹, Ran Wang¹, Saurabh Chawla², Metin Basaranoglu³, Xingshun Qi⁴

Affiliations

¹ Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, China.
² Division of Digestive Diseases, Department of Internal Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
³ Division of Gastroenterology, Department of Internal Medicine, Medical School, Bezmialem Vakif University, Istanbul, Turkey.
⁴ Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China.

Abstract

Background: The association of endoscopic variceal treatment (EVT) with portal venous system thrombosis (PVST) in liver cirrhosis is still unclear.

Methods: PVST was assessed by contrast-enhanced CT or MRI in 406 cirrhotic patients from our prospective database. Case and control groups, which are defined as patients with and without PVST, respectively, were matched at a ratio of 1:1 according to age, gender, Child-Pugh class, and MELD score. History of EVT was reviewed. Logistic regression analysis was used to identify the risk factors for PVST. Odds ratios (ORs) were calculated. Subgroup analyses were further performed in terms of degree and location of PVST.

Results: Overall, 109 patients each were included in case and control groups. The case group had a significantly higher proportion of patients who had undergone EVT than the control group (53.2% versus 18.3%; p < 0.001). In detail, the case group had significantly higher proportions of patients who had undergone EVT for controlling bleeding (45.9% versus 14.7%; p < 0.001), endoscopic variceal ligation (EVL) alone (19.3% versus 9.2%; p = 0.033), and EVL combined with endoscopic cyanoacrylate glue injection (24.8% versus 5.5%; p < 0.001). EVT was independently associated with PVST (OR = 4.258; p < 0.001). In subgroup analyses, EVT remained independently associated with partial PVST (OR = 10.063; p < 0.001), complete PVST/fibrotic cord (OR = 4.889; p = 0.008), thrombosis within main portal vein (OR = 5.985; p < 0.001), and thrombosis within superior mesenteric and splenic veins (OR = 5.747; p < 0.001).

Conclusions: EVT may lead to a higher risk of PVST, especially more severe PVST, in liver cirrhosis. Screening for and prophylaxis of PVST after EVT should be further explored.

Keywords: cirrhosis; endoscopy; portal vein; risk factors; venous thrombosis.