Endoscopic surveillance in patients with oesophageal varices in alcoholic liver cirrhosis
Background: Oesophageal varices is one of the most common complications in liver cirrhosis and can be seen in almost 50% of patients, with an annual bleeding risk of 10–15% and a 6-week mortality rate of up to 25%.1 Endoscopy is the gold standard test for early detection and prevention of complicati...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001101 |
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| Summary: | Background: Oesophageal varices is one of the most common complications in liver cirrhosis and can be seen in almost 50% of patients, with an annual bleeding risk of 10–15% and a 6-week mortality rate of up to 25%.1 Endoscopy is the gold standard test for early detection and prevention of complications.2 However, adherence to guidelines is not systematically evaluated. This study assessed adherence to endoscopic guidelines, barriers to adherence and their association between progression of disease and mortality. Methods: This was a retrospective study that examined alcoholic liver cirrhosis patients who underwent an endoscopy study at Ealing Hospital. Data collection for this study was performed following registration with Clinical Audit and Governance team at London North West University Healthcare NHS Trust with Registration No: St.M.EH.24.200.This study was performed to assess adherence to endoscopic surveillance guidelines, in particular Baveno VI3 and VII,4 to determine whether patients had endoscopic evaluations at recommended timelines: every 2–3 years in patients with compensated cirrhosis and every 1–4 weeks until eradication, followed by scheduled follow-up in decompensated cirrhosis.To explore the impact of adherence on disease progression and mortality, statistical analyses, including Chi-square tests and binary logistic regression, were performed, thus allowing vigorous testing of relationship between compliance, clinical outcomes and potential barriers to adherence to surveillance. Results: The total number of patients included was 177; 77% men (n=137) and 22.6% women (n=22.6%). In terms of age groups, 51–60 years (29.9%) and 61–70 years (27.1%) collectively accounted for more than half the study population. In general, 57.6% of patients adhered to recommended endoscopic surveillance guidelines, while 42.4% did not. The major reasons behind non-compliance were missed appointments (26.7%), mental health problems (16.7%), mortality(15.6%) and split care between centres (15.6%) (Fig 1).Chi-square test (p=0.007) showed significant association between surveillance guidelines and progression of disease. Among the patients who followed recommended guidelines, 66% had stable disease and 55% showed clinical improvement. By contrast, disease progression was seen in 59% of patients who did not adhere to the recommended guidelines (Table 1).In addition, binary logistic regression showed that disease progression (B=–2.636, p=0.005, OR=0.072) and disease severity (B=0.786, p=0.006, OR=2.195) were significant predictors of mortality. Although adherence to surveillance guidelines plays a major role in stability of disease, it was not statistically associated with mortality (p=0.183). Thus, overall survival is directly influenced by disease severity and progression rather than by adherence to guidelines alone. Conclusion: This study suggests adherence to endoscopic surveillance leads to stable disease and lower progression rates. Disease burden and severity remain central in predicting mortality. Essentially, non-compliance was primarily attributed to missed appointments, mental health issues and split care. Addressing these barriers could enhance adherence, reducing disease progression, and improved long-term outcomes. Recommendations: Improved compliance requires streamlined referrals, automated remainders and proper patient education. In addition, multidisciplinary collaboration, enhanced community outreach and digital tracking improve patient outcomes in the long-term. |
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| ISSN: | 1470-2118 |