Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.
Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.
J Dig Dis. 2020 Mar;21(3):170-178. doi: 10.1111/1751-2980.12847. Epub 2020 Mar 11.
To investigate whether second-look endoscopy (SLE)-guided therapy could be used to prevent post-endoscopic variceal ligation (EVL) early bleeding.
Consecutive cirrhotic patients with large esophageal varices (EV) receiving successful EVL for acute variceal bleeding (AVB) or secondary prophylaxis were enrolled. The patients were randomized into a SLE group and a non-SLE group (NSLE) 10 days after EVL. Additional endoscopic interventions as well as proton pump inhibitors and octreotide administration were applied based on the SLE findings. The post-EVL early rebleeding and mortality rates were compared between the two groups.
A total of 252 patients were included in the final analysis. Post-EVL early rebleeding (13.5% vs 4.8%, P = 0.016) and bleeding-caused mortality (4.8% vs 0%, P = 0.013) were more frequently observed in the NSLE group than in the SLE group. However, post-EVL early rebleeding and mortality rates were reduced by SLE in patients receiving EVL for AVB only but not in those receiving secondary prophylaxis. Patients with Child-Pugh classification B to C at randomization (hazard ratio [HR] 8.77, P = 0.034), AVB at index EVL (HR 3.62, P = 0.003), discontinuation of non-selective β-blocker after randomization (HR 4.68, P = 0.001) and non-SLE (HR 2.63, P = 0.046) were more likely to have post-EVL early rebleeding. No serious adverse events occurred during SLE.
SLE-guided therapy reduces post-EVL early rebleeding and mortality rates in cirrhotic patients with large EV receiving EVL for AVB.
研究二探内镜（SLE）引导的治疗是否可用于预防内镜下食管静脉曲张结扎（EVL）后早期出血。
连续纳入因急性静脉曲张出血（AVB）或二级预防而行 EVL 成功治疗的大食管静脉曲张（EV）的肝硬化患者。患者在 EVL 后 10 天随机分为 SLE 组和非 SLE 组（NSLE）。根据 SLE 结果，对两组均进行额外的内镜干预以及质子泵抑制剂和奥曲肽的应用。比较两组患者的 EVL 后早期再出血和死亡率。
共纳入 252 例患者进行最终分析。NSLE 组的 EVL 后早期再出血（13.5% vs 4.8%，P = 0.016）和出血导致的死亡率（4.8% vs 0%，P = 0.013）均高于 SLE 组。然而，SLE 仅降低了因 AVB 而行 EVL 的患者的 EVL 后早期再出血和死亡率，但不能降低因二级预防而行 EVL 的患者的 EVL 后早期再出血和死亡率。随机分组时为 Child-Pugh 分类 B 至 C（风险比 [HR] 8.77，P = 0.034）、索引 EVL 时为 AVB（HR 3.62，P = 0.003）、随机分组后停用非选择性β受体阻滞剂（HR 4.68，P = 0.001）和非 SLE（HR 2.63，P = 0.046）的患者更有可能发生 EVL 后早期再出血。SLE 过程中未发生严重不良事件。
在因 AVB 而行 EVL 的大 EV 肝硬化患者中，SLE 引导的治疗可降低 EVL 后早期再出血和死亡率。
