Abstract
Objective This study is aimed at evaluating the survival of cirrhotic patients with different etiologies after endoscopic therapy for acute variceal bleeding and the effect of repeated endotherapy on patients' prognosis. Methods We retrospectively evaluated the clinical features and outcomes between cirrhotic patients with chronic HBV or HCV infections and other etiologies. The 3-year and 5-year survival rates and rehemorrhage rate in one year between the viral and nonviral cirrhosis patients were compared by Kaplan-Meier curves and log-rank test. Cox analysis was used to identify the impact factors that affect the long-term survival of patients with cirrhosis and variceal bleeding after endotherapy. Results Out of 2665 patients with liver cirrhosis and variceal hemorrhage selected from our medical center between September 2008 and December 2017, a total of 1342 patients were included for analysis. The median follow-up duration was 32.9 months (range 0.16-111.4 months), the 3- and 5-year cumulative survival rates were 75.3% and 52.8%, respectively. The median survival time was significantly longer in viral cirrhosis patients (47.1 months [95% CI: 24.9-69.1]) compared with nonviral cirrhosis patients (37.0 months [95% CI: 25.0-56.0], p = 0.001). The 3-year and 5-year survival rates of the viral group were higher than the nonviral group. The rehemorrhage rate at one year was higher in nonviral patients than in viral patients (p < 0.001). Conclusion Repeated endotherapy combined with effective antiviral therapy is helpful for long-term survival of cirrhotic population with variceal hemorrhage and HBV or HCV infection.
Highlights
Acute variceal bleeding (AVB) is a fatal complication in patients with liver cirrhosis, which is associated with increased mortality of about 20% at six weeks, despite recent progress in management
We retrospectively analyzed 1342 liver cirrhosis patients with variceal bleeding after endotherapy in our hospital during the past decade
A total of 2665 patients with liver cirrhosis and variceal bleeding after endotherapy were assessed in the study
Summary
Acute variceal bleeding (AVB) is a fatal complication in patients with liver cirrhosis, which is associated with increased mortality of about 20% at six weeks, despite recent progress in management. It was reported that 92% of patients admitted for acute gastric variceal bleeding achieved successful hemostasis after the injection of cyanoacrylate [9]. Combined treatment with vasoactive drugs, prophylactic antibiotics, and endoscopic techniques is the recommended standard of care for patients with AVB [10]. EVL combined with a vasoactive drug is considered the standard care for AVB, which is recommended by BAVENO VI [11]. The longterm effect of ligation plus cyanoacrylate injection with or without sclerotherapy of variceal bleeding in cirrhotic patients with concomitant esophageal and gastric varices remains unclear
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