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

• Published in: Scientific reports Vol. 12; no. 1; p. 20726
• Main Authors: Kondo, Takayuki, Fujiwara, Kisako, Nakagawa, Miyuki, Unozawa, Hidemi, Iwanaga, Terunao, Sakuma, Takafumi, Fujita, Naoto, Koroki, Keisuke, Kanzaki, Hiroaki, Kobayashi, Kazufumi, Kiyono, Soichiro, Nakamura, Masato, Kanogawa, Naoya, Saito, Tomoko, Ogasawara, Sadahisa, Suzuki, Eiichiro, Ooka, Yoshihiko, Nakamoto, Shingo, Chiba, Tetsuhiro, Arai, Makoto, Kato, Jun, Kato, Naoya
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-12-2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4020; 692/4020/4021; Bleeding; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - diagnostic imaging; Computed tomography; Endoscopy; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - etiology; Hepatocellular carcinoma; Humanities and Social Sciences; Humans; Liver cancer; Liver Neoplasms - complications; Liver Neoplasms - diagnostic imaging; multidisciplinary; Multivariate analysis; Patients; Portal vein; Retrospective Studies; Science; Science (multidisciplinary); Thrombosis; Tomography; Tomography, X-Ray Computed; Tumors; Varicose Veins
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-25350-8

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.