Multiparametric ultrasound for the prediction of the short-term outcome after esophageal varices band ligation

BACKGROUND Endoscopic variceal band ligation (EVBL) represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis, but in some cases a single session of EVBL is unable to eradicate esophageal varices completely, and a control endoscopy after 2-4 weeks is required to assess eradication and/or the need for another band ligation. Liver stiffness measurement (LSM) is being increasingly used as a screening non-invasive tool to predict varices according to Baveno VII criteria. However, to date, there are no instruments able to non-invasively predict the outcome of EVBL. AIM To identify non-invasive predictors of varices eradication (VE) after EVBL through multiparametric ultrasound (US). Secondary aim was to develop a prediction model of successful variceal eradication based on non-invasive parameters. METHODS We prospectively enrolled consecutive cirrhotic patients intolerant or with contraindications to beta-blockers undergoing EVBL for bleeding prophylaxis. Patients underwent multiparametric US with LSM, spleen stiffness measurement (SSM) and dynamic contrast-enhanced US (DCE-US) on liver parenchyma and portal vein, at baseline (T0) and one month (T1) after EVBL. Each US parameter and their variations from baseline were correlated with VE evaluated by control endoscopy performed at T1. RESULTS We enrolled 41 patients (median age 64 years, 75.6% males). At T1 28 patients (68.3%) reached VE, whereas 13 (31.7%) required a second EVBL. Patients who achieved VE showed a significant decrease in SSM (P = 0.018), and a significant increase in peak enhancement, area under the curve and wash-in rate of both liver parenchyma and portal vein after treatment (P < 0.001). Statistically significant differences between the two groups of patients were incorporated in a multivariate analysis and used to develop three prediction models. CONCLUSION A multimodal US approach based on DCE-US parameters, LSM and SSM might become a reliable predictor of VE and a useful non-invasive alternative to endoscopy.