Comparative analysis of endoscopic ligation and tissue adhesive injection for tortuous gastric varices / 中华消化内镜杂志

ABSTRACT

Objective:To evaluate the risks and benefits of endoscopic ligation and tissue adhesive injection for tortuous gastric varices.Methods:A total of 193 patients with esophagogastric varices, who underwent endoscopic variceal ligation or endoscopic tissue adhesive injection in Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from June 2015 to June 2020, were included in the retrospective analysis. These cases were connected vessels (type Le and gf based on LDRf standard) of tortuous gastric varices (F1 in Hashizume standard). According to the treatment, the patients were divided into three groups gastric fundus and esophageal ligation group (endoscopic ligation of gastric fundus and esophageal varices, 32 cases), tissue adhesive group (endoscopic tissue adhesive injection of gastric varices, endoscopic ligation of esophageal varices, 71 cases) and esophageal ligation group (endoscopic ligation of esophageal varices, 90 cases). The re-bleeding rate, the effectiveness rate, the significant effectiveness rate and complications of the three groups were compared.Results:The rates of re-bleeding in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 18.75% (6/32), 12.68% (9/71) and 3.33% (3/90), respectively.There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=6.110, P<0.016). The effectiveness rates of the three groups were all 100.00%. The significant effectiveness rates in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 37.50% (12/32), 25.35% (18/71) and 14.44% (13/90), respectively. There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=7.702, P<0.016). No pulmonary infection, hepatic encephalopathy, spontaneous bacterial peritonitis or perforation occurred in the three groups.The incidences of chest pain or abdominal pain in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 18.75% (6/32), 11.27% (8/71) and 2.22% (2/90), respectively.There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=10.524, P<0.016). There was no significant difference in the incidence of fever, nausea or vomiting among the three groups ( P>0.05). Conclusion:Simultaneous endoscopic ligation of gastric fundus and esophageal varices, and endoscopic tissue adhesive injection of gastric varices combined with endoscopic ligation of esophageal varices is of no benefit for patients with tortuous gastric varices, but endoscopic ligation of esophageal varices alone may yield more benefit.