-Original-

Visceral Fat Associated with Worsening of Recurrent Esophageal Varices in Alcoholic/Nonalcoholic Steatohepatitis-Related Liver Cirrhosis

Ryohei Nishiguchi¹, Yoshihiro Furuichi², Takeshi Shimakawa¹, Shinichi Asaka¹, Kentaro Yamaguchi¹, Yukio Shimojima¹, Teppei Kono¹, Sachiyo Okayama¹, Rieko Shimojima², Masano Sagawa¹, Kotaro Kuhara¹, Takebumi Usui¹, Hajime Yokomizo¹, Seiji Ohigashi¹, Koichiro Sato², Hiroyuki Kato² and Shunichi Shiozawa¹

¹Department of Surgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
²Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan

Background: Alcoholic steatohepatitis and nonalcoholic steatohepatitis-related liver cirrhosis (ASH/NASH-LC) are major causes of esophageal varices (EVs). However, the association between high visceral fat and exacerbation of EVs remains unclear. The aim of this study was to clarify the association of visceral fat and recurrence rate of EVs in ASH/NASH-LC and to identify independent predictors associated with recurrence.
Methods: We retrospectively evaluated data from 94 patients who underwent endoscopic injection sclerotherapy for EVs with ASH/NASH-LC. Using the receiver operating characteristic curve for the cut-off value of visceral fat index (VFI; 46.4 cm²/m²), we classified patients as having a high VFI (n = 53) or low VFI (n = 41). Propensity score matching was used to align for background factors, and the recurrence rate of EVs was compared between the two groups. Predictors associated with esophageal variceal recurrence were identified by multivariate analysis. The recurrence rate in patients with viral LC was also investigated.
Results: In the overall analysis, the recurrence rate was significantly higher in the high VFI group than in the low VFI group (P = 0.023). The recurrence rate was also higher in the high VFI group than in the low VFI group after propensity score matching, in which 19 patients were matched in each group (P = 0.048). VFI and Child-Pugh score were independently associated with recurrence. Recurrence rates were comparable between the two groups in viral LC patients.
Conclusions: Worsening of variceal recurrence was observed in high visceral fat patients in ASH/NASH-LC but not in viral LC. Furthermore, high visceral fat was an independent predictor associated with variceal recurrence.

J Nippon Med Sch 2024; 91: 362-370

Keywords
alcoholic steatohepatitis-related liver cirrhosis, nonalcoholic steatohepatitis-related liver cirrhosis, endoscopic injection sclerotherapy, visceral fat

Correspondence to
Yoshihiro Furuichi, Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kohoku, Adachi-ku, Tokyo 123-8558, Japan
furu-chan@shirt.ocn.ne.jp

Received, November 13, 2023
Accepted, February 9, 2024