Abstract
AimTo establish a therapeutic strategy for cirrhosis patients with gastric variceal bleeding.MethodsThe outcomes of 137 patients with bleeding gastric varices were evaluated.ResultsThe bleeding source was gastroesophageal varices (GOV) in 86 patients, and gastric fundal varices (FV) in 51 patients. The Child-Turcotte-Pugh classes were A, B, and C in 26, 79, and 32 patients, respectively; 34 patients (24.8%) had hepatocellular carcinoma (HCC), of which 11 also had complicating portal venous tumor thrombosis (PVTT). Patients with GOV were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with FV were treated by EIS with cyanoacrylate; 29 patients with FV also underwent additional balloon-occluded retrograde transvenous obliteration (BRTO). Hemostasis was successfully achieved in 136 patients (99.3%), and the cumulative 1-year, 3-year, and 5-year rebleeding rates were 18.1%, 30.8%, and 30.8%, respectively, in the patients with GOV, and 2.2%, 12.5% and 12.5%, respectively, in the patients with FV. The overall 1-year, 3-year, and 5-year survival rates were 79.7%, 71.5% and 64.4%, respectively, in the patients with GOV, and 91.0%, 76.9% and 59.5%, respectively, in the patients with FV. Multivariable analysis identified PVTT and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival.ConclusionsEndoscopic therapies with or without BRTO appeared to be useful therapeutic strategies to prevent rebleeding in patients with gastric variceal bleeding, and favorable outcomes were obtained, except in patients with underlying HCC associated with PVTT and/or severe liver damage.
Highlights
Bleeding varices is one of the major causes of death in patients with liver cirrhosis, and emergency intensive care is often required to rescue these patients [1]
Patients with gastroesophageal varices (GOV) were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with fundal varices (FV) were treated by EIS with cyanoacrylate; 29 patients with FV underwent additional balloon-occluded retrograde transvenous obliteration (BRTO)
Multivariable analysis identified portal venous tumor thrombosis (PVTT) and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival
Summary
Bleeding varices is one of the major causes of death in patients with liver cirrhosis, and emergency intensive care is often required to rescue these patients [1]. Varices can develop at any site along the gastrointestinal tract in patients with portal hypertension, but gastric varices are encountered less frequently than esophageal varices, and are present in about 20% of patients with cirrhosis [4]. Gastric varices are classified into two types: gastroesophageal varices (GOV) and isolated gastric varices (IGV). GOV extend beyond the gastroesophageal junction, connecting with esophageal varices. According to the classification by the Japan Society for Portal Hypertension [6], Lg-c gastric varices correspond to GOV-1 and GOV-2, and Lg-cf or Lg-f gastric varices correspond to IGV-1; the latter are referred to as gastric fundal varices (FV)
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