Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Gut Liver. 2020 Jan 15;14(1):117-124. doi: 10.5009/gnl18392.
Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.
胃静脉曲张 (GV) 内镜套扎术后再出血可能是致命的。本研究旨在评估 CT 对 EVO 治疗 GV 出血后再出血的预测价值。纳入接受 EVO 治疗 GV 出血并在 EVO 前后进行 CT 检查的患者。回顾性分析门静脉期 CT 显示预处理 GV 和供血血管的图像，以及非增强 CT 显示治疗后氰基丙烯酸酯栓塞的图像。共纳入 53 例患者，平均年龄为 60.6±11.6 岁，40 例（75.5%）为男性。最常见的基础肝病是酒精性肝病（45.3%）。40 例（75.5%）和 24 例（45.3%）患者的 GV 和供血血管中的氰基丙烯酸酯完全栓塞。在随访期间，9 例患者发生 GV 再出血，GV 再出血的累积发生率在 3、6 和 12 个月时分别为 11.8%、18.9%和 18.9%。GV 再出血率与 GV 中氰基丙烯酸酯完全栓塞无显著差异，而与供血血管中氰基丙烯酸酯完全栓塞显著相关。在供血血管不完全栓塞的患者中，GV 再出血的累积发生率在 3、6 和 12 个月时分别为 22.3%、35.2%和 35.2%，而在供血血管完全栓塞的患者中无再出血（p=0.002）。腹部 CT 有助于评估 EVO 治疗 GV 出血后的治疗反应。供血血管中氰基丙烯酸酯不完全栓塞是 GV 再出血的危险因素。
