Effects of extremely high hepatic venous pressure gradient on short-term prognosis of endoscopic therapy in secondary prophylaxis for patients with gastroesophageal varices

Abstract

Objective To evaluate effects of extremely high hepatic venous pressure gradient (HVPG) on the prognosis of endoscopic therapy in secondary prophylaxis for patients with gastroesophageal varices. Methods This was a single center prospective cohort study. From April 1st, 2013 to May 31st, 2015, patients with gastroesophageal varices and treated for secondary prophylaxis were enrolled and divided into extremely high HVPG group (HVPG≥20 mmHg, 1 mmHg=0.133 kPa) and non-extremely high HVPG group (HVPG<20 mmHg). After combination of endoscopic ligation and tissue glue treatment, one-year, two-year and three-year rebleeding rates and survival statuses were compared. Cox regression was performed for further analysis of prognosis factors related with rebleeding and survive. Results Eventually, 126 patients were enrolled and divided into extremely high HVPG group (32 cases) and non-extremely high HVPG group (94 cases). The one-year rebleeding rates of extremely high HVPG group and non-extremely high HVPG group were 37.9% (11/29) and 27.6% (24/87), respectively, and the difference was not statistically significant (χ2=1.105, P=0.293). The two-year rebleeding rate of extremely high HVPG group was significantly higher than non-extremely high HVPG group 51.7% (15/29) vs 29.9% (26/87), and the difference was statistically significant (χ2=4.539, P=0.033). And so was the three-year rebleeding rate, 51.7% (15/29) vs 29.9% (24/87), and the difference was statistically significant (χ2=4.539, P=0.033). The one-year, two-year and three-year survival rates of extremely high HVPG group and non-extremely high HVPG group were 92.6% (25/27) vs 94.0% (78/83), 85.2% (23/27) vs 94.0% (78/83), and 85.2% (23/27) vs 94.0% (78/83), and the differences between two groups were not statistically significant (all P>0.05). Single factor analysis showed that portal vein thrombosis was associated with rebleeding (hazard ratio (HR)=1.883, 95% confidence interval (CI) 1.015 to 3.492, P=0.045). No prognosis factors associated with survival were found. Conclusions Medium and long term rebleeding rate of the extremely high HVPG group is higher than that of the non-extremely high HVPG group. Extremely high HVPG does not affect the one-year prognosis of endoscopic therapy in secondary prophylaxis for patients with gastroesophageal varices. Key words: Hepatic venous pressure gradient; Esophageal and gastric varices; Secondary prophylaxis; Endoscopic therapy