1111 Clinical Significance of Isolated Gastric Varices in Liver Cirrhosis Patients: Re-Visited the Unsolved Problem

Abstract

INTRODUCTION: Gastric varices (GV) presents in 10-30% of liver cirrhosis patients with mortality rate up to 45%. Isolated gastric varices rupture is less frequent than esophageal varices (EV) rupture, but the hemorrhage is often more severe, more difficult to control, and have higher risk of recurrent bleeding and mortality. However, there are still debatable and no clear consensus yet about optimal management especially for incidentally discovered IGV. METHODS: This was a cohort retrospective endoscopy database study at Dr. Cipto Mangunkusumo National General Hospital from 2016 until 2017. All liver cirrhosis (LC) patients’ database who underwent upper GI endoscopy were included. Patients without the presence of varices, patients with malignancy or uncomplete database were excluded. Patients’ characteristic including MELD score, and Child Pugh score were collected for data analysis. Data analysis was performed using IBM SPSS version 23 for Windows. RESULTS: Of 328 patients, there were 153 patients that can be included in this study with the mean age 51 years old. The most prevalent etiology of liver disease is hepatitis B virus. Child Pugh (CP) A was found in 74 (48.36%) patients, CP B was found in 53 (34.64%) patients, and CP C was found in 26 (16.99%) patients. Isolated GV (IGV) was found in 13 (8.49%) patients, meanwhile esophageal varices (EV) found in 112 (73.20%) patients, and both (Gastroesophageal Varices/GOV) in 28 (18.30%) patients. CP C, GV and EV were found to be independent risk factors for variceal bleeding. CP C is still the strongest independent risk factor for variceal bleeding occurrence in bivariate (HR: 10.21, 95% CI:4.15-25.12 P .001) as well as in multivariate analysis (HR: 12.49, 95% CI: 4.95-31.54 0 0.001), whereas the presence of GOV is an independent risk factor associated with bleeding incidence in bivariate analysis (HR: 2.51, 95% CI: 1.26-4.99 P .009) as well as in multivariate analysis (HR: 2.95, 95% CI: 1.40-6.19 P .004) but not IGV. However, CP C score is still the only significant risk factor associated with survival liver cirrhosis patients based on multivariate analysis (HR: 26.77 95% CI: 6.01-119.34 P .001). CONCLUSION: The concern of high potential of bleeding occurrence in the presence of IGV sometimes give a clinical dilemma regarding the potential risk and side effect of endoscopic therapy for IGV. Our study results showed that the presence of IGV is not the strongest risk factor for bleeding occurrence as well as patient's survival.