Incidence of the appearance of the red color sign on esophageal varices and its predictive factors: long-term observations of 359 patients with cirrhosis

Purpose. The red color sign observed by endoscopic examination is a reliabl e predictive factor for variceal bleeding. The aim of this study was to cal culate the incidence of the appearance of the red color sign and to evaluat e its predictive factors. Methods. Endoscopic examination was repeatedly pe rformed in 359 consecutive patients diagnosed as having liver cirrhosis wit h or without esophageal varices, during a median follow-up period of 2651 d ays. Results. The incidence of the appearance of the red color sign on esop hageal varices at the end of the tenth year was compared among patients wit hout varices (11.4%), those with small varices (45.4%), and those with mid- size varices (65.0%). The difference was significant (P < 0.0001). The numb er of varices (P = 0.0010), size of varices (P = 0.0064), platelet count (P = 0.0168), and alpha-fetoprotein level (P = 0.0207) were significantly cor related with the appearance of the red color sign, as estimated by the mult ivariate Cox hazard model. To exclude the influence of carcinogenesis, obse rvation was stopped when hepatocellular carcinoma was discovered. Additive predictive factors with significance were: number of varices (P = 0.001), s ize of varices (P = 0.027), and platelet count (P = 0.0315). Conclusions. E ndoscopic signs of esophageal varices and platelet count were significant p redictors for the appearance of the red color sign.