The Impact of Esophagogastric Varices on the Outcomes of Patients With Cholangiocarcinoma.

INTRODUCTION: Esophagogastric varices (EGV) are known to correlate with a poorer prognosis in patients with liver cirrhosis or hepatocellular carcinoma. However, their clinical significance in patients with cholangiocarcinoma (CCA) remains unknown. The aim of this study was to investigate the impact of EGV on the outcomes of patients with CCA. METHODS: This retrospective study enrolled 923 consecutive treatment-naive patients diagnosed with CCA between January 2013 and December 2023. Among these, 321 patients received esophagogastroduodenoscopy at the time of CCA diagnosis. The primary end point was to assess the impact of EGV on overall survival (OS) in patients with CCA, whereas the secondary end point was to identify the predictive factors for the occurrence of EGV. RESULTS: Of the patients analyzed, 47 (14.6%) were diagnosed with EGV by esophagogastroduodenoscopy. Among these, 39 patients did not receive primary prophylaxis for EGV bleeding and were classified as the EGV group, whereas the remaining 274 patients (85.4%) formed the non-EGV group. The median OS was shorter in the EGV group than that in the non-EGV group (182 vs 357 days, P = 0.009). Multivariate analyses identified the presence of EGV as an independent risk factor of poorer OS (hazard ratio 1.823, confidence interval 1.248-2.663, P = 0.002). Besides, fibrosis-4 scores >2.67 and albumin-bilirubin grades >1 were predictive factors for EGV occurrence. DISCUSSION: While the prevalence of concurrent EGV in patients with CCA was relatively low, its presence was associated with a poorer prognosis. The fibrosis-4 scores and albumin-bilirubin grades predicted the occurrence of EGV.