Influence of portal vein thrombosis on clinical efficacy of endoscopic esophageal variceal ligation

Abstract

Objective To explore the influence of portal vein thrombosis (PVT) on the clinical efficacy of endoscopic esophageal variceal ligation (EVL) in cirrhotic patients with esophagogastric variceal hemorrhage (EVH). Methods Clinical data of 314 cirrhotic patients with EVH who underwent endoscopic EVL and were followed up for more than 6 months in the Third Affiliated Hospital of Sun Yat-sen University between January 2005 and December 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into the PVT group and the control group according to whether they had PVT during treatment. Among the 72 patients in the PVT group, 61 were males and 11 were females with the mean age of (50±11) years old. Among the 242 patients in the control group, 206 were males and 36 were females with the mean age of (47±11) years old. The clinical efficacy of two groups was compared, and the correlation between PVT and the elimination rate of esophageal varices (EV) as well as the recurrent bleeding rate of EV was analyzed. The number of EVL treatment period in two groups was compared using t test and the rate was compared using Chi-square test. Univariate logistic regression analysis was conducted for the correlation between PVT and the elimination rate, recurrent bleeding rate of EV. Results Thirty-six patients in the PVT group and 115 patients in the control group developed acute EVH. After EVL, the emergency hemostatic rate of both groups was 100%. The elimination rate of EV in the PVT group was 76%(55/72), significantly lower than 90%(218/242) in the control group (χ2=9.166, P<0.05). The number of EVL treatment period in the PVT group was 3.4±1.6, significantly more than 2.8±1.1 in the control group (t=3.065, P<0.05). The recurrent bleeding rate of EV in the PVT group was 36%(26/72), significantly higher than 21%(51/242) in the control group (χ2=6.779, P<0.05). PVT was a risk factor for both the elimination rate of EV (OR=0.356, 95%CI: 0.179-0.709, P<0.05) and the recurrent bleeding rate of EV (OR=2.383, 95%CI: 1.354-4.196, P<0.05). Conclusion PVT is a risk factor for both the elimination rate of EV and the recurrent bleeding rate of EV in cirrhotic patients with EVH treated by endoscopic EVL. Key words: Portal vein; Neoplastic cells, circulating; Liver cirrhosis; Esophageal and gastric varices; Gastroscopes; Therapeutic uses