Endoscopic Ultrasound Findings Predicting Esophageal Variceal Recurrence after Eradication by Endoscopic Band Ligation

Background and study aim: Recurrence of oesophageal varices (OV) following endoscopic eradication is a major clinical challenge in patients with portal hypertension, often leading to significant morbidity and mortality. Endoscopic ultrasound (EUS) has emerged as a promising modality for evaluating vascular hemodynamics and predicting variceal recurrence risk; however, its prognostic value remains under investigation. This study aimed to assess the utility of EUS in predicting early recurrence of oesophageal varices after band ligation in patients with portal hypertension.Patients and Methods: A prospective cohort of 48 patients with obliterated OV following band ligation was enrolled at Zagazig University Hospital. EUS was performed to evaluate peri- and para-oesophageal collaterals, perforator veins, and hepatofugal flow in the left gastric vein. Patients were followed for up to 18 months, and OV recurrence was monitored using scheduled endoscopic examinations. Statistical analyses were conducted to identify vascular predictors of recurrence.Results: EUS detected para- and peri-oesophageal collaterals in 70.8% of patients. Extensive para-oesophageal collaterals (>5 mm), significant peri-oesophageal collaterals (>2 mm), presence of perforator veins, and high hepatofugal flow velocity (>12 cm/s) were significantly associated with early OV recurrence (within three months, p<0.05). Patients with small or absent collaterals exhibited delayed or no recurrence.Conclusion: EUS is a valuable non-invasive tool for identifying high-risk vascular features associated with early OV recurrence after endoscopic band ligation. Incorporating EUS findings into routine follow-up may facilitate timely interventions and improve outcomes in patients with portal hypertension.