CT Scans Show Promise in Predicting, Managing Bleeding Risk in Liver disease Patients – New Research
New findings suggest that CT scans can effectively identify patients at high risk of recurrent esophageal variceal (EV) bleeding, a life-threatening complication of cirrhosis-not-to-be-ignored/” title=”5 early signs of … not to be ignored”>liver disease, perhaps allowing for proactive intervention. A retrospective study analyzing data from a single institution demonstrated a correlation between the size of submucosal esophageal varices visible on CT scans and the likelihood of re-bleeding. Researchers propose utilizing CT scans – particularly with contrast – to identify high-risk patients who might benefit from procedures like partial splenic artery embolization.
The study, published recently, focused on patients with cirrhosis and hepatocellular carcinoma (HCC) who underwent endoscopic intervention for EV bleeding. analysis of prior CT scans revealed that larger submucosal varices were considerably associated with recurrent bleeding events. This suggests CT imaging could serve as a valuable tool alongside endoscopy, offering a faster and more readily available assessment, especially during off-hours.
“CT surveillance could provide several pieces of facts, including the risk of the next EV bleeding, besides assessing treatment response of HCC,” the authors state. They point to the speed and accessibility of CT scans as advantages over endoscopy, despite acknowledging endoscopy remains the gold standard for both diagnosis and treatment.
Though, the researchers also highlighted several limitations. The study’s retrospective design and single-institution focus necessitate further validation through larger, multi-center prospective trials. The lack of routine post-endoscopic contrast-enhanced CT scans limited their ability to fully assess residual varices and re-bleeding risk. Furthermore, the study only included patients who were candidates for and received endoscopic treatment, potentially underestimating the overall incidence of recurrent bleeding. The complex, multifactorial nature of EV bleeding – influenced by factors like HCC burden, portal pressure, and overall health – also wasn’t fully explored.
Despite these limitations, the study underscores the potential for radiologists and clinicians to recognize large submucosal EVs on CT scans as a warning sign, prompting consideration of more aggressive treatment strategies to improve patient outcomes.future research should focus on a more comprehensive understanding of portosystemic shunts and the interplay of various factors contributing to EV bleeding in cirrhotic patients with HCC.
Sources:
Koconis KG, Singh H, Soares G.Partial Splenic embolization in the treatment of patients with portal hypertension: a review of the english Language literature. J Vasc Interv radiol. 2007;18:463-81. Martino A, Amitrano L, Guardascione M, Di Serafino M, Bennato R, Martino R, de Leone A, Orsini L, Romano L, Lombardi G. The role of computed tomography for the prediction of esophageal variceal bleeding: current status and future perspectives. World J Gastrointest Endosc. 2023;15(12):681-9.
* Elhendawy M, Elkalla F. Computed tomography for prediction of esophageal variceal bleeding. World J Gastrointest Endosc. 2024;16(3):175-7.