Department of Hepatology, Christian Medical College, Vellore, India.
Department of Radiology, Christian Medical College, Vellore, India.
J Gastroenterol Hepatol. 2020 Aug;35(8):1397-1403. doi: 10.1111/jgh.14971. Epub 2020 Jan 16.
This aims to study incidence of re-bleeding on anticoagulation and survival of Budd-Chiari syndrome (BCS) patients presenting with variceal bleeding.
Budd-Chiari syndrome patients presenting with variceal bleed between 01/01/2007 and 01/05/2019 were retrospectively studied. Patients underwent endoscopic treatment ± endovascular therapy, followed by anticoagulation. Variceal re-bleed (on anticoagulation) and survival were studied.
Of 376 BCS patients diagnosed during the study period, 40 (10.7%) patients, presenting with variceal bleed (age 33 [25-40] years; male patients 70%; Rotterdam score 1.13 [0.63-1.22]), Group 1 were compared with 40 randomly selected age-matched BCS patients presenting with ascites, no bleeds (40 [23-42] years; male patients 42.5%; Rotterdam score 1.11 [1.09-1.16]), Group 2. The commonest site of obstruction was hepatic vein (65%) in Group 1 and combined hepatic veins and inferior vena cava (57.5%) in Group 2 (P < 0.01). Thirty-six Group 1 patients underwent endoscopic intervention (variceal ligation, 33; sclerotherapy, 2; glue injection, 1). Endovascular intervention was performed in 30 Group 1 patients (angioplasty ± stent, 22; endovascular shunt, 8) and in 34 Group 2 patients (angioplasty ± stent, 26; endovascular shunt, 8). All 80 patients were started on anticoagulation. Variceal bleed on anticoagulation occurred in five patients in Group 1 and three patients in Group 2. One-year and 5-year survival were 94.2% and 87.5%, respectively, in Group 1 and 100% and 80%, respectively, in Group 2.
About one-tenth of BCS patients present with variceal bleed. On management with endoscopic ± endovascular therapy, followed by anticoagulation, variceal re-bleed in these patients were comparable with those in BCS patients presenting with ascites and survival was excellent at 1 and 5 years.
本研究旨在探讨伴有食管静脉曲张出血的布加综合征（BCS）患者抗凝治疗后再出血的发生率和生存情况。
回顾性研究了 2007 年 1 月 1 日至 2019 年 1 月 5 日期间因食管静脉曲张出血而就诊的 BCS 患者。所有患者均接受了内镜治疗+血管内治疗，随后进行抗凝治疗。研究了再出血（抗凝治疗期间）和生存情况。
在研究期间诊断的 376 例 BCS 患者中，40 例（10.7%）因食管静脉曲张出血（年龄 33[25-40]岁；男性患者 70%；Rotterdam 评分 1.13[0.63-1.22]）就诊，记为第 1 组，与 40 例随机选择的年龄匹配的因腹水而就诊、无出血的 BCS 患者（40[23-42]岁；男性患者 42.5%；Rotterdam 评分 1.11[1.09-1.16]）进行了比较，记为第 2 组。第 1 组中最常见的梗阻部位是肝静脉（65%），第 2 组中则是肝静脉和下腔静脉联合（57.5%）（P<0.01）。第 1 组中有 36 例患者接受了内镜治疗（食管静脉曲张结扎术 33 例；硬化治疗 2 例；胶注射 1 例），30 例患者接受了血管内治疗（血管成形术+支架置入术 22 例；血管内分流术 8 例），34 例患者接受了血管内治疗（血管成形术+支架置入术 26 例；血管内分流术 8 例）。所有 80 例患者均开始接受抗凝治疗。第 1 组中有 5 例患者和第 2 组中有 3 例患者在抗凝治疗期间出现食管静脉曲张出血。第 1 组的 1 年和 5 年生存率分别为 94.2%和 87.5%，第 2 组的 1 年和 5 年生存率分别为 100%和 80%。
约十分之一的 BCS 患者以食管静脉曲张出血为首发表现。这些患者在接受内镜+血管内治疗后，再接受抗凝治疗，其再出血率与以腹水为首发表现的 BCS 患者相似，且 1 年和 5 年生存率均较高。
