ABSTRACT
Objective:To investigate the predictors of rebleeding three months after treatment of esophageal and gastric variceal bleeding (EGVB) in patients with hepatitis B cirrhosis and the effects of different treatments on rebleeding.Methods:From January 2018 to January 2020, the hepatitis B cirrhosis patients with first onset of EGVB in the First Hospital of Lanzhou University were enrolled and followed up for three months. The development of rebleeding, information about portal vein flow velocity and model for end-stage liver disease (MELD) scores after treatment of first bleeding were collected. The statistical analysis was conducted by chi-square test and binary logistic regression analysis. The efficacy for predictors of rebleeding was evaluated by using area under the receiver operating characteristic curve.Results:Among the 33 patients with the first EGVB, the rebleeding rate during three months follow-up was 42% (14 cases), including one patient (1/8) who underwent transjugular intrahepatic portosystemic shunt, 10 patients (10/19) were treated with therapeutic endoscopy, and three patients (3/6) were treated with vasoactive drugs. No statistically significant difference in rebleeding rates was found among the three treatment groups ( χ2=3.853, P=0.175). Portal vein flow velocity after treatment for the first onset of EGVB (odds ratio ( OR)=0.21, 95% confidence interval ( CI) 0.05 to 0.93, P=0.039) and MELD score ( OR=1.53, 95% CI 1.02 to 2.30, P=0.040) were independent predictors for the occurrence of rebleeding events during three months. When the portal vein flow velocity after treatment for the first bleeding was 19 cm/s, the area under the receiver operating characteristic curve for prediction of the occurrence of rebleeding during three months was 0.86, with the sensitivity of 92% and the specificity of 61%. Conclusion:Among the patients with hepatitis B cirrhosis and the first onset of EGVB, different treatments may have little relationship with three-month rebleeding, while portal vein flow velocity ≤19 cm/s is the main predictor for rebleeding within three months.
ABSTRACT
BACKGROUND/AIMS: Though endoscopic therapies such as variceal ligation and sclerotherapy has been performed, bleeding from the large esophageal and gastric varices still poses significant risk of death. Decrease of portal pressure by TIPS (transjugular intrahepatic portosystemic shunt) or surgical shunt was indicated as cause of failure of endoscopic therapies. Treatment of N-butyl-2-cyanoacrylate has been especially effective for gastric variceal bleeding, but comparison with other treatments had not been reported yet. In this study, the effect of cyanoacrylate injection therapy was cross-examined with the result of TIPS in acute esophagogastric variceal bleedings. METHODS: From April 1995 to June 2002, endoscopic cyanoacrylate injection therapy (43 cases) and TIPS (63 cases) were performed in our hospital. Each group was analysed regarding their clinical results including initial hemostasis rate, rebleeding rate, survival duration, mortality and morbidity. RESULTS: Initial hemostasis rate was 95.3% in cyanoacrylate group and 92.1% in TIPS group. Cumulative probability of rebleeding was not different between two groups. Overall complication rates associated with the procedure were 50.8% in TIPS group and 9.3% in cyanoacrylate group. There was no significant difference between two groups in their survival rates. CONCLUSIONS: Cyanoacrylate injection therapy was relatively safe, and has comparable results with TIPS for uncontrollable and severe esophagogastric variceal bleedings.