Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Multiparametric ultrasound for the prediction of the short-term outcome after esophageal varices band ligation
Maria Elena Ainora, Raffaele Borriello, Silvia Pecere, Mattia Paratore, Linda Galasso, Valentin Calvez, Giorgio Esposto, Irene Mignini, Federico Barbaro, Livio Enrico Del Vecchio, Francesca Romana Ponziani, Brigida Eleonora Annicchiarico, Matteo Garcovich, Laura Riccardi, Maurizio Pompili, Cristiano Spada, Antonio Gasbarrini, Maria Assunta Zocco
Maria Elena Ainora, Raffaele Borriello, Mattia Paratore, Linda Galasso, Valentin Calvez, Giorgio Esposto, Irene Mignini, Francesca Romana Ponziani, Brigida Eleonora Annicchiarico, Matteo Garcovich, Laura Riccardi, Maurizio Pompili, Antonio Gasbarrini, Maria Assunta Zocco, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
Silvia Pecere, Federico Barbaro, Livio Enrico Del Vecchio, Cristiano Spada, Endoscopia Chirurgica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
Co-first authors: Maria Elena Ainora and Raffaele Borriello.
Author contributions: Zocco MA contributed to conceptualization; Ainora ME, Borriello R, Pecere S and Zocco MA contributed to methodology; Paratore M and Calvez V contributed to formal analysis; Ainora ME, Borriello R, Esposto G, Mignini I, Galasso L, Garcovich M, Barbaro F, Del Vecchio LE contributed to investigation; Ainora ME, Borriello R, Galasso L, Paratore M and Calvez V contributed to data curation; Borriello R, Ainora ME, Pecere S contributed to writing original draft; Borriello R, Ainora ME, Esposto G, Zocco MA contributed to editing; Pompili M, Zocco MA, Riccardi L, Ponziani FR, Annicchiarico BE, Spada C, Gasbarrini A contributed to supervision.
Institutional review board statement: The study protocol was approved by the University Hospital “Agostino Gemelli” IRCCS Institutional Review Board (No. 2986).
Clinical trial registration statement: the study was registered at clinicaltrials.gov (No. NCT05789641).
Informed consent statement: All patients provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Data are available from corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Maria Assunta Zocco, MD, Professor, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Gemelli 1, Rome 00168, Italy.
mariaassunta.zocco@unicatt.it
Received: July 2, 2025
Revised: August 19, 2025
Accepted: September 16, 2025
Published online: October 28, 2025
Processing time: 120 Days and 19.7 Hours
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.
Core Tip: Follow-up endoscopy is commonly used to assess treatment response after endoscopic variceal band ligation (EVBL) in cirrhotic patients. This study evaluated the usefulness of multiparametric ultrasound to predict the short-term outcome of EVBL in patients with liver cirrhosis. We identified significant parameters associated with variceal eradication such as liver and spleen stiffness and longitudinal changes in dynamic contrast enhanced ultrasound variables. This approach could support the usefulness of multiparametric ultrasound for non-invasive evaluation of EVBL efficacy.
