Monographic Research·Noninvasive Diagnosis and Treatment of Portal Hypertension
Clinical evaluation of different modalities in emergency endoscopic treatment of esophageal variceal bleeding
Huang Xiaoquan, Wu Ling, Jiang Siyu, Ni Liyuan, Li Feng, Chen Shiyao, Ma Lili
Published 2022-05-20
Cite as J Chin Physician, 2022, 24(5): 653-657. DOI: 10.3760/cma.j.cn431274-20220419-00361
Abstract
ObjectiveThis study aimed to evaluate the rebleeding risk and prognosis of patients being treated after acute esophageal varices bleeding by two different treatment strategies: sclerosing agent combined with tissue glue injection, esophageal varices ligation (EVL), through comparing the therapeutic effects and securities.
MethodsA total of 76 patients who underwent endoscopy and received treatment in Zhongshan Hospital Affiliated to Fudan University due to acute esophageal variceal bleeding were included retrospectively. 6 patients with active bleeding and 70 patients with thrombus in esophagus varices under gastroscopy. Among them, 21 cases were treated with sclerosing agent combined with tissue glue injection (sclerosing tissue glue group), and 55 cases were treated with EVL (EVL group). The emergency endoscopic diagnosis and treatment of the two groups were compared, and the risk factors of rebleeding 6 months after endoscopic treatment were analyzed by univariate and multivariate analysis.
ResultsAll patients received endoscopic treatment successfully. During the follow-up period of 6 months after endoscopic treatment, rebleeding occurred in 13 cases. Kaplan Meier analysis showed that the 6-month rebleeding rate in the sclerosing tissue glue group was significantly higher than that in the EVL group (41.6% vs 12.3%, P=0.011). There were 8 deaths in total. Kaplan Meier analysis showed that there was no significant difference in 6-month mortality between the two groups (17.5% vs 10.1%, P=0.616). Multivariate analysis further showed that malignant tumor (HR=3.700, 95% CI: 1.187-11.536, P=0.024) and treatment mode of esophageal variceal bleeding (HR=4.834, 95% CI: 1.443-16.193, P=0.011) were independent risk factors for rebleeding 6 months after endoscopic treatment of acute esophageal variceal bleeding.
ConclusionsThis study found that EVL and the combining injection of lauromacrogol and cyanoacrylate could be used in emergent hemostatic treatment for acute esophageal varices bleeding. Moreover, EVL is the prioritized approach in endoscopic emergency treatment with a lower rebleeding rate and fewer complications. Sclerotherapy combined with tissue glue can be used as one of the measures of emergency treatment, which is not better than ligation.
Key words:
Hemostasis, endoscopic; Esophageal varices; Endoscopic variceal ligation; Endoscopic cyanoacrylate injection
Contributor Information
Huang Xiaoquan
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Wu Ling
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jiang Siyu
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Ni Liyuan
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Li Feng
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Chen Shiyao
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Department of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Ma Lili
Department of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Department of Endoscopy, Wusong Branch, Zhongshan Hospital, Fudan University, Shanghai 200940, China
