■内镜下静脉曲张结扎术(EVL)后出血可能是多种因素的结果,包括直径太大无法完全结扎的食管静脉曲张(EV)。本研究旨在开发一种基于人工智能的内窥镜虚拟尺(EVR)来测量EV的直径,以期找到更适合EVL的病例。
■本研究是一项多中心回顾性研究,包括727例肝硬化合并EV患者的1,062例EVL,从2016年4月到2023年3月接受EVL。根据术后6周是否发生出血分为早期再出血组(n=80)和非再出血组(n=982)。患者基线数据的特点,分析术后6周的再出血情况和再出血后6周的生存状况.
■1,062例EVL手术后的早期再出血率为7.5%,出血后6周死亡率为16.5%。单因素二元logistic回归分析的结果表明,EVL后早期再出血的危险因素包括:高TB(P=0.009),低Alb(P=0.001),高PT(P=0.004),PVT(P=0.026),肝癌(P=0.018),高Child-Pugh评分(P<0.001),Child-PughC级(P<0.001),高MELD评分(P=0.004),日本静脉曲张F3级(P<0.001),EV直径(P<0.001),结扎环数(P=0.029)。多因素二元logistic回归分析的结果表明,Child-PughC级(P=0.007),日本静脉曲张F3级(P=0.009),和EV直径(P<0.001)可能在预测EVL后早期再出血方面表现出潜力。ROC分析表明,EV直径的曲线下面积(AUC)为0.848,日本静脉曲张等级的AUC为0.635,具有统计学意义(P<0.001)。因此,本研究的结果表明,与日本静脉曲张分级标准相比,EV直径在预测EVL术后早期再出血方面更优.EV直径的截止值计算为1.35cm(灵敏度,70.0%;特异性,89.2%)。
■如果EV的直径≥1.4cm,EVL手术后可能存在早期再出血的高风险;因此,我们建议谨慎使用EVL。
UNASSIGNED: Bleeding following endoscopic variceal ligation (EVL) may occur as a result of numerous factors, including a diameter of esophageal varices (EV) that is too large to be completely ligated. The present
study aimed to develop an artificial intelligence-based endoscopic virtual ruler (EVR) to measure the diameter of EV with a view to finding more suitable cases for EVL.
UNASSIGNED: The present
study was a multicenter retrospective
study that included a total of 1,062 EVLs in 727 patients with liver
cirrhosis with EV, who underwent EVL from April 2016 to March 2023. Patients were divided into early rebleeding (n = 80) and non-rebleeding groups (n = 982) according to whether postoperative bleeding occurred at 6 weeks. The characteristics of patient baseline data, the status of rebleeding at 6 weeks after surgery and the survival status at 6 weeks after rebleeding were analyzed.
UNASSIGNED: The early rebleeding rate following 1,062 EVL procedures was 7.5%, and the mortality rate at 6 weeks after bleeding was 16.5%. Results of the one-way binary logistic regression analysis demonstrated that the risk factors for early rebleeding following EVL included: high TB (P = 0.009), low Alb (P = 0.001), high PT (P = 0.004), PVT (P = 0.026), HCC (P = 0.018), high Child-Pugh score (P < 0.001), Child-Pugh grade C(P < 0.001), high MELD score(P = 0.004), Japanese variceal grade F3 (P < 0.001), diameter of EV (P < 0.001), and number of ligature rings (P = 0.029). Results of the multifactorial binary logistic regression analysis demonstrated that Child-Pugh grade C (P = 0.007), Japanese variceal grade F3 (P = 0.009), and diameter of EV (P < 0.001) may exhibit potential in predicting early rebleeding following EVL. ROC analysis demonstrated that the area under curve (AUC) for EV diameter was 0.848, and the AUC for Japanese variceal grade was 0.635, which was statistically significant (P < 0.001). Thus, results of the present
study demonstrated that EV diameter was more optimal in predicting early rebleeding following EVL than Japanese variceal grade criteria. The cut-off value of EV diameter was calculated to be 1.35 cm (sensitivity, 70.0%; specificity, 89.2%).
UNASSIGNED: If the diameter of EV is ≥1.4 cm, there may be a high risk of early rebleeding following EVL surgery; thus, we recommend caution with EVL.