Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan.
PLoS One. 2022 Mar 15;17(3):e0264359. doi: 10.1371/journal.pone.0264359. eCollection 2022.
To establish a therapeutic strategy for cirrhosis patients with gastric variceal bleeding.
The outcomes of 137 patients with bleeding gastric varices were evaluated.
The bleeding source was gastroesophageal varices (GOV) in 86 patients, and gastric fundal varices (FV) in 51 patients. The Child-Turcotte-Pugh classes were A, B, and C in 26, 79, and 32 patients, respectively; 34 patients (24.8%) had hepatocellular carcinoma (HCC), of which 11 also had complicating portal venous tumor thrombosis (PVTT). Patients with GOV were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with FV were treated by EIS with cyanoacrylate; 29 patients with FV also underwent additional balloon-occluded retrograde transvenous obliteration (BRTO). Hemostasis was successfully achieved in 136 patients (99.3%), and the cumulative 1-year, 3-year, and 5-year rebleeding rates were 18.1%, 30.8%, and 30.8%, respectively, in the patients with GOV, and 2.2%, 12.5% and 12.5%, respectively, in the patients with FV. The overall 1-year, 3-year, and 5-year survival rates were 79.7%, 71.5% and 64.4%, respectively, in the patients with GOV, and 91.0%, 76.9% and 59.5%, respectively, in the patients with FV. Multivariable analysis identified PVTT and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival.
Endoscopic therapies with or without BRTO appeared to be useful therapeutic strategies to prevent rebleeding in patients with gastric variceal bleeding, and favorable outcomes were obtained, except in patients with underlying HCC associated with PVTT and/or severe liver damage.
为肝硬化合并胃静脉曲张出血患者建立治疗策略。
评估了 137 例出血性胃静脉曲张患者的结局。
86 例患者的出血源为胃食管静脉曲张（GOV），51 例患者为胃底静脉曲张（FV）。Child-Turcotte-Pugh 分级分别为 A、B 和 C 的患者有 26、79 和 32 例；34 例（24.8%）患者患有肝细胞癌（HCC），其中 11 例还伴有门静脉肿瘤血栓形成（PVTT）。GOV 患者采用内镜下静脉曲张结扎术或内镜下乙醇胺油酸注射硬化疗法（EIS）治疗，FV 患者采用氰基丙烯酸酯 EIS 治疗；29 例 FV 患者还接受了附加的球囊阻塞逆行经静脉闭塞术（BRTO）。136 例患者（99.3%）成功止血，GOV 患者的 1 年、3 年和 5 年再出血率分别为 18.1%、30.8%和 30.8%，FV 患者分别为 2.2%、12.5%和 12.5%。GOV 患者的总体 1 年、3 年和 5 年生存率分别为 79.7%、71.5%和 64.4%，FV 患者分别为 91.0%、76.9%和 59.5%。多变量分析确定 PVTT 和酒精性肝硬化是再出血的显著相关危险因素，终末期肝病模型（MELD）评分和 PVTT 是生存的显著相关因素。
内镜治疗联合或不联合 BRTO 似乎是预防胃静脉曲张出血患者再出血的有效治疗策略，除了患有伴有 PVTT 和/或严重肝损伤的基础 HCC 患者之外，都获得了良好的结果。
