Future directions of noninvasive prediction of esophageal variceal bleeding: No worry about the present computed tomography inefficiency

Abstract

In this editorial, we comment on the minireview by Martino A, published in the recent issue of World Journal of Gastrointestinal Endoscopy 2023; 15 (12): 681-689. We focused mainly on the possibility of replacing the hepatic venous pressure gradient (HVPG) and endoscopy with noninvasive methods for predicting esophageal variceal bleeding. The risk factors for bleeding were the size of the varices, the red sign and the Child-Pugh score. The intrinsic core factor that drove these changes was the HVPG. Therefore, the present studies investigating noninvasive methods, including computed tomography, magnetic resonance imaging, elastography, and laboratory tests, are working on correlating imaging or serum marker data with intravenous pressure and clinical outcomes, such as bleeding. A single parameter is usually not enough to construct an efficient model. Therefore, multiple factors were used in most of the studies to construct predictive models. Encouraging results have been obtained, in which bleeding prediction was partly reached. However, these methods are not satisfactory enough to replace invasive methods, due to the many drawbacks of different studies. There is still plenty of room for future improvement. Prediction of the precise timing of bleeding using various models, and extracting the texture of variceal walls using high-definition imaging modalities to predict the red sign are interesting directions to lay investment on.

Keywords: Esophageal variceal bleeding; Prediction; noninvasive; Computed tomography; Hepatic venous pressure gradient; Endoscopy

Core Tip: Current imaging techniques, especially computed tomography, are helpful for describing some of the characteristics that may explain the severity of portal hypertension. However, studies on radiomics have not achieved good results in accurately predicting variceal bleeding. In future studies, more delicate features of the images (especially the texture of variceal walls) could be focused on to reveal subtle signs of correlation.