Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2024; 16(3): 108-111
Published online Mar 16, 2024. doi: 10.4253/wjge.v16.i3.108
Future directions of noninvasive prediction of esophageal variceal bleeding: No worry about the present computed tomography inefficiency
Yu-Hang Zhang, Bing Hu
Yu-Hang Zhang, Bing Hu, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang YH and Hu B contributed to this paper; Zhang YH designed, drafted and revised the manuscript; Hu B contributed the concept.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Bing Hu, MD, Doctor, Full Professor, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. hubing@wchscu.cn
Received: December 27, 2023
Peer-review started: December 27, 2023
First decision: January 16, 2024
Revised: January 16, 2024
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: March 16, 2024
Processing time: 78 Days and 0.6 Hours
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.