Lu Zheng, Sun Xiaotian, Zhang Wenhui, Jin Bo, Han Jingjing, Wang Yanling, Han Jun, Ma Xuemei, Liu Bo, Wu Libing, Wu Qin, Yu Xiaoli, Li Hanwei
Liver Cirrhosis Diagnosis and Treatment Center, the Fifth Medical Center of Chinese PLA General Hospital.
Department of Internal Medicine, Clinic of August First Film Studio, Beijing South Medical District, Chinese PLA General Hospital, Beijing, China.
Medicine (Baltimore). 2020 Mar;99(11):e19485. doi: 10.1097/MD.0000000000019485.
Urgent endoscopy (UE) is important to the diagnosis and treatment of liver cirrhosis patients with esophageal variceal bleeding (EVB). It was reported that a second-look endoscopy may benefit acute upper gastrointestinal bleeding (UGIB) caused by peptic ulcer, while whether it could improve UGIB caused by liver cirrhosis associated EVB remains unclear. This study aimed to investigate the characteristics of second UE for liver cirrhosis with EVB and further examined the potential prognostic factors.Patients aged ≥18 years who underwent UE for EVB within 2 hours after the admission were included and divided into scheduled second-look group (n = 245) and uncontrolled bleeding group (n = 352) based on the indications for second UE within 48 hours after initial endoscopy. Demographic and clinical data were collected and analyzed. Univariate and multivariate analysis were used to identify the risk factors for prognosis. The value of different scoring system was compared.Statistical differences were found on history of bleeding and hepatocellular carcinoma, ascites, endoscopic type of bleeding, between scheduled second-look group and uncontrolled bleeding group. Univariate and multivariate logistic regression analysis confirmed that ascites, hemoglobin <60 g/L, AIMS65 score and failure to identify in initial UE were independent risk factors for bleeding uncontrolled after initial UE, and age, bilirubin level, initial unsatisfactory UE hemostasis, failure to identify bleeding on initial UE and tube/urgent TIPS suggested in initial UE were independent risk factors for 42-day mortality.A second-look UE could bring benefit for liver cirrhosis patients with EVB without increasing the complication rate.
急诊内镜检查（UE）对于肝硬化合并食管静脉曲张破裂出血（EVB）患者的诊断和治疗至关重要。据报道，二次内镜检查可能有益于消化性溃疡所致急性上消化道出血（UGIB），而其能否改善肝硬化合并EVB所致UGIB尚不清楚。本研究旨在探讨肝硬化合并EVB患者二次UE的特点，并进一步研究潜在的预后因素。纳入年龄≥18岁、入院后2小时内接受EVB的UE检查的患者，并根据初次内镜检查后48小时内二次UE的指征将其分为计划二次检查组（n = 245）和出血未控制组（n = 352）。收集并分析人口统计学和临床数据。采用单因素和多因素分析确定预后的危险因素。比较不同评分系统的价值。计划二次检查组和出血未控制组在出血史、肝细胞癌、腹水、内镜下出血类型方面存在统计学差异。单因素和多因素logistic回归分析证实，腹水、血红蛋白<60 g/L、AIMS65评分以及初次UE未明确出血部位是初次UE后出血未控制的独立危险因素，年龄、胆红素水平、初次UE止血效果不佳、初次UE未明确出血部位以及初次UE建议行置管/紧急经颈静脉肝内门体分流术（TIPS）是42天死亡率的独立危险因素。二次UE可为肝硬化合并EVB患者带来益处，且不增加并发症发生率。
