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Title: [A prognostic analysis of cirrhotic esophageal variceal bleeding treated with standardized endoscopic therapy].
Author: Dai YP, Gao Q.
Journal: Zhonghua Gan Zang Bing Za Zhi; 2017 Mar 20; 25(3):195-199. PubMed ID: 28482406.
Abstract:
Objective: To analyze the clinical effect of standardized endoscopic esophageal variceal ligation alone or in combination with tissue adhesive injection for gastric varices (GV) after the first cirrhotic esophageal variceal bleeding. Methods: A total of 97 patients who underwent a successful endoscopic therapy in our hospital due to the first cirrhotic esophageal variceal bleeding were enrolled, and according to the subsequent therapeutic regimen, they were divided into control group (48 patients) and treatment group (49 patients). The patients in the control group were given conservative treatment alone, and those in the treatment group were given endoscopic therapy regularly. The therapeutic regimen, changes in varices, complications, and death caused by rebleeding were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between groups. Results: The treatment group achieved a remission rate of esophageal varices (EV) of 100% and a GV elimination rate of 93.75% after 2-3 times of endoscopic therapy; the EV recurrence, rebleeding, and mortality rates were 2.04%, 0, and 0, respectively, within 1 month, 16.33%, 4.08%, and 0, respectively, within 12 months, and 20.40%, 14.29%, and 4.08%, respectively, within 20 months; the incidence rate of gastric variceal bleeding (GVB) was 0. In the control group, the EV recurrence, rebleeding, and mortality rates were 4.17%, 2.08%, and 2.08%, respectively, within 1 month, 41.67%, 33.33%, and 8.33%, respectively, within 12 months, and 72.92%, 56.25%, and 20.83%, respectively, within 20 months; the incidence rate of GVB was 18.75%. There were significant differences between the two groups in the incidence rate of GVB (χ (2) = 13.605, P = 0.001) and EV long-term recurrence, rebleeding, and mortality rates (12 months: χ (2) = 16.326, P < 0.01; 20 months: χ (2) = 27.144, P < 0.01). Conclusion: Gastroscopy and continuous endoscopic therapy for 2-3 times should be performed regularly after the first cirrhotic esophageal variceal bleeding to alleviate EV, eliminate GV, and reduce rebleeding and mortality rates. 目的： 分析肝硬化食管静脉曲张(EV)首次出血后，规范行内镜下食管静脉曲张套扎术或联合胃静脉曲张(GV)组织胶注射术的临床效果。 方法： 收集因肝硬化EV出血首次行内镜治疗成功的97例患者，按后续治疗方案分为两组，对照组48例仅接受保守治疗，治疗组49例规律内镜治疗,记录分析两组治疗方案、静脉曲张变化及并发症、再出血死亡等的差异。计量资料组间比较采用t检验，计数资料组间比较采用χ(2)检验或Fisher确切概率法。 结果： 治疗组连续2～3次内镜治疗后EV缓解率100%、GV消除率93.75%；EV复发率、再出血率、病死率:1个月内分别为2.04%、0、0，12个月内分别为16.33%、4.08%、0，20个月内分别为20.40%、14.29%、4.08%,胃静脉曲张出血(GVB)发生率为0。对照组：EV复发率、再出血率、病死率：1个月内分别为4.17%、2.08%、2.08%，12个月内分别为41.67%、33.33%、8.33%，20个月内分别为72.92%、56.25%、20.83%，GVB发生率为18.75%。两组GVB发生率（χ(2) = 13.605，P < 0.01）及EV远期复发率、出血率、病死率（12个月，χ(2) = 16.326，P<0.01；20个月，χ(2) = 27.144，P<0.01）差异均有统计学意义。 结论： 肝硬化EV首次出血后应规律胃镜随访、连续内镜治疗2～3次，以缓解EV程度、消除GV、降低再出血病死率。.

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