Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Clin Gastroenterol Hepatol. 2010 Aug;8(8):703-8. doi: 10.1016/j.cgh.2010.02.022. Epub 2010 Mar 11.
BACKGROUND & AIMS: Esophageal variceal hemorrhage (EVH) is a serious complication of cirrhosis, with 20% mortality per episode. The 2007 American Association for the Study of Liver Disease and American College of Gastroenterology practice guidelines regarding esophageal varices in patients with cirrhosis recommend screening and intervention to prevent EVH. We assessed practice guideline compliance and its impact on the rate of first EVH.
An institutional review board-approved retrospective chart review was conducted on a random sample of adult patients newly evaluated for cirrhosis at the Cleveland Clinic from 2003 to 2006 (n = 179). Exclusion criteria were a previous diagnosis of esophageal varices or EVH and/or treatment with beta-adrenergic antagonists. Patients were followed for 23 months (range, 9-38 months). Conformity with practice guidelines and subsequent bleeding rates were determined. Observed bleeding rates were compared to the North Italian Endoscopy Club (NIEC) model.
Of the patients, 94% had a screening endoscopy, 80% within 6 months of the initial visit. Varices were present in 50% of the patients; 68% of all patients screened and 91% with large varices received a practice guideline-recommended treatment. Twelve patients (7%) had an episode of EVH; 82% of subjects without bleeding had their screening endoscopy within 6 months versus 50% of those with bleeding (P = .016). Actuarial likelihood of bleeding at 2 years was 13% versus 27% predicted by the NIEC model (P < .05).
Compliance with practice guideline recommendations is associated with reduction in first EVH in the first 2 years.
食管静脉曲张出血（EVH）是肝硬化的严重并发症，每次发作的死亡率为 20%。2007 年美国肝病研究协会和美国胃肠病学会关于肝硬化患者食管静脉曲张的实践指南建议筛查和干预以预防 EVH。我们评估了实践指南的依从性及其对首次 EVH 发生率的影响。
对克利夫兰诊所 2003 年至 2006 年新评估为肝硬化的成年患者进行了机构审查委员会批准的回顾性图表审查（n = 179）。排除标准为先前诊断为食管静脉曲张或 EVH 和/或β肾上腺素能拮抗剂治疗。患者随访 23 个月（范围，9-38 个月）。确定了与实践指南的一致性和随后的出血率。观察到的出血率与北意大利内镜俱乐部（NIEC）模型进行了比较。
94%的患者进行了筛查内镜检查，80%在初次就诊后 6 个月内进行。50%的患者存在静脉曲张；所有筛查患者中有 68%和所有大静脉曲张患者中有 91%接受了推荐的实践指南治疗。12 例（7%）发生 EVH；无出血的 82%患者在 6 个月内进行了筛查内镜检查，而出血的 50%患者（P =.016）。2 年内出血的累积可能性为 13%，而 NIEC 模型预测为 27%（P <.05）。
遵守实践指南建议与降低前 2 年内首次 EVH 相关。
