The impact of esophagogastric varices on the outcomes of patients with cholangiocarcinoma

Background & Aim: 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. This study aimed 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 (EGD) at the time of CCA diagnosis. The primary endpoint was to assess the impact of EGV on overall survival (OS) in patients with CCA, while the secondary endpoint was to identify the predictive factors for the occurrence of EGV. Results: Of the patients analyzed, 47 (14.6%) were diagnosed with EGV by EGD. Among these, 39 patients did not receive primary prophylaxis for EGV bleeding and were classified as the EGV group, while the remaining 274 (85.4%) formed the non-EGV group. The median OS was shorter in the EGV group than in the non-EGV group (182 vs. 357 days, p =0.009). Multivariate analyses identified the presence of EGV as an independent risk factor for poorer OS (hazard ratio: 1.823, confidence interval: 1.248- 2.663, p = 0.002). Besides, fibrosis- 4 (FIB-4) scores > 2.67 and albumin-bilirubin (ALBI) grades > 1 were predictive factors for EGV occurrence. Conclusion: While the prevalence of concurrent EGV in CCA patients was relatively low, its presence was associated with a poorer prognosis. The FIB-4 scores and ALBI grades predicted the occurrence of EGV.