Zaman Atif, Hapke Ronald J, Flora Kenneth, Rosen Hugo R, Benner Kent G
Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon 97201, USA.
Am J Gastroenterol. 2004 Apr;99(4):645-9. doi: 10.1111/j.1572-0241.2004.04145.x.
In mid-1997 the American College of Gastroenterology (ACG) published guidelines for the management of varices. The aim of this study is to assess the change in regional practice patterns between early 1997 (preguidelines) and 2000 (postguidelines).
Gastroenterologists in Oregon and Southwestern Washington state were sent a self-reporting questionnaire regarding the management of varices in March 1997 (prior to the publication of the guidelines) and again in August 2000.
Fifty-seven of 75 (76%) and 68 of 92 (74%) of the surveys were completed in 1997 and 2000, respectively. Fifty to 60% of the respondents saw between three and five cirrhotic patients per month. Significantly, more respondents followed the guidelines to screen and treat large varices to prevent initial variceal hemorrhage in 2000 than in 1997, 54% versus 18% (p < 0.005). Of the respondents who performed screening of EGDs, the majority treated large varices with beta-blocker therapy (93% in 1997 and 97% in 2000). All respondents used early endoscopy to treat variceal bleeding. Significantly, most of the respondents began pharmacologic therapy prior to endoscopy if active variceal hemorrhage was suspected (with most choosing octreotide) in 2000 than in 1997, 83% versus 56% (p < 0.005). The majority of the respondents pursued repeat endoscopic therapy after cessation of the initial variceal bleeding episode (96% in 1997 and 95% in 2000), and most performed surveillance EGD once the varices had been eradicated (72% in 1997 and 79% in 2000).
After the publication of the ACG guidelines, significantly more gastroenterologists screened for varices to prevent initial variceal hemorrhage and significantly more used pharmacologic therapy prior to endoscopic treatment for variceal hemorrhage.
1997年年中，美国胃肠病学会（ACG）发布了静脉曲张管理指南。本研究的目的是评估1997年初（指南发布前）至2000年（指南发布后）区域实践模式的变化。
1997年3月（指南发布前）和2000年8月，分别向俄勒冈州和华盛顿州西南部的胃肠病学家发送了一份关于静脉曲张管理的自填式问卷。
1997年和2000年分别完成了75份调查中的57份（76%）和92份调查中的68份（74%）。50%至60%的受访者每月诊治3至5名肝硬化患者。值得注意的是，2000年遵循指南筛查和治疗大静脉曲张以预防初次静脉曲张出血的受访者比1997年显著增多，分别为54%和18%（p<0.005）。在进行内镜检查筛查的受访者中，大多数采用β受体阻滞剂治疗大静脉曲张（1997年为93%，2000年为97%）。所有受访者均采用早期内镜治疗静脉曲张出血。值得注意的是，2000年与1997年相比，如果怀疑有活动性静脉曲张出血，大多数受访者在进行内镜检查之前开始药物治疗（大多数选择奥曲肽），分别为83%和56%（p<0.005）。大多数受访者在初次静脉曲张出血发作停止后进行重复内镜治疗（1997年为96%，2000年为95%），并且大多数在静脉曲张根除后进行内镜监测（1997年为72%，2000年为79%）。
ACG指南发布后，显著更多的胃肠病学家筛查静脉曲张以预防初次静脉曲张出血，并且显著更多的人在静脉曲张出血的内镜治疗之前使用药物治疗。
