Martínez-Díaz FM, Jiménez-Cuevas EA, Morales-Galicia AE, Ramírez-Mejía MM, Qi XS, Poo JL, Méndez-Sánchez N. Toward noninvasive prediction of treatment outcomes in patients with variceal bleeding. World J Gastroenterol 2026; 32(11): 115723 [DOI: 10.3748/wjg.v32.i11.115723]
Corresponding Author of This Article
Nahum Méndez-Sánchez, MD, MSc, PhD, Liver Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Colonia Toriello Guerra, Mexico City 14050, Mexico. nmendez@medicasur.org.mx
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
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World J Gastroenterol. Mar 21, 2026; 32(11): 115723 Published online Mar 21, 2026. doi: 10.3748/wjg.v32.i11.115723
Toward noninvasive prediction of treatment outcomes in patients with variceal bleeding
Fernanda M Martínez-Díaz, Elsie A Jiménez-Cuevas, Arnulfo E Morales-Galicia, Mariana M Ramírez-Mejía, Xing-Shun Qi, Jorge L Poo, Nahum Méndez-Sánchez
Fernanda M Martínez-Díaz, Elsie A Jiménez-Cuevas, Nahum Méndez-Sánchez, Liver Research Unit, Medica Sur Clinic and Foundation, Mexico City 14050, Mexico
Arnulfo E Morales-Galicia, Mariana M Ramírez-Mejía, Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04360, Mexico
Xing-Shun Qi, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
Jorge L Poo, Centro de Innovación y Educación Ejecutiva, Tecnológico de Monterrey, Mexico City 14380, Mexico
Author contributions: Méndez-Sánchez N, Martínez-Díaz FM, Jiménez-Cuevas EA, Morales-Galicia AE, Ramírez-Mejía MM, Qi XS, and Poo JL contributed to this paper; Méndez-Sánchez N designed the overall concept and outline of the manuscript; Martínez-Díaz FM, Jiménez-Cuevas EA, Morales-Galicia AE, and Ramírez-Mejía MM contributed to the discussion and design of the manuscript; Méndez-Sánchez N, Martínez-Díaz FM, Jiménez-Cuevas EA, Morales-Galicia AE, Ramírez-Mejía MM, Qi XS, and Poo JL contributed to the writing and editing of the manuscript, illustrations, and literature review. All authors approved the final version to publish.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Nahum Méndez-Sánchez, MD, MSc, PhD, Liver Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Colonia Toriello Guerra, Mexico City 14050, Mexico. nmendez@medicasur.org.mx
Received: October 24, 2025 Revised: December 17, 2025 Accepted: January 20, 2026 Published online: March 21, 2026 Processing time: 143 Days and 7 Hours
Abstract
We read with great interest the article by Ainora et al. Esophageal variceal bleeding is among the most serious and feared complications of cirrhosis and is responsible for considerable morbidity, high rates of rebleeding and significant mortality. Its onset reflects severe portal hypertension (pHTN) and often signals a turning point in disease progression. Its treatment requires urgent stabilization and effective strategies to prevent recurrence. The standard treatment is endoscopic variceal band ligation (EVBL) and medical treatment, which remains the cornerstone of primary and secondary prophylaxis. However, follow-up continues to rely on repeated endoscopies, which are invasive, resource intensive, and uncomfortable for patients. Although alternative tools are limited, the hepatic venous pressure gradient is the gold standard for assessing pHTN; however, methods for its measurement are invasive and not widely available. Moreover, noninvasive approaches such as elastography or the Baveno criteria, although useful for risk stratification, have not been validated for predicting short-term outcomes after EVBL. The lack of reliable predictors underscores a need for novel approaches. Multiparametric ultrasound (MP-US), which combines measurements of liver and spleen stiffness with perfusion imaging, offers a comprehensive, noninvasive assessment of pHTN. The study by Ainora et al reveals that the use of MP-US can help identify patients most likely to achieve variceal eradication, reducing the number of unnecessary procedures and guiding individualized follow-up. The aim of this editorial is to review the clinical impact of variceal bleeding; to examine the limitations of current follow-up strategies after EVBL; and to analyze the rationale, potential, and challenges related to MP-US as an emerging tool in this context.
Core Tip: Esophageal variceal bleeding represents one of the most lethal complications of cirrhosis, with high rebleeding and mortality rates despite standard therapy involving endoscopic variceal band ligation. Current follow-up strategies rely on repeated endoscopy and hepatic venous pressure gradient measurements, which are both invasive and resource intensive, whereas noninvasive tools such as elastography and the Baveno criteria lack validation for predicting post-endoscopic variceal band ligation outcomes. Multiparametric ultrasound, by integrating measurement of liver and spleen stiffness with perfusion imaging, offers a comprehensive, noninvasive assessment of portal hypertension and may enable individualized follow-up, reduce procedural burden, and improve patient-centered care.
