Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008, Jiangsu, China.
BMC Gastroenterol. 2022 May 2;22(1):213. doi: 10.1186/s12876-022-02283-0.
Risk stratification to identify patients with high risk of variceal rebleeding is particularly important in patients with decompensated cirrhosis. In clinical practice, eliminating gastroesphageal varices thoroughly after sequential endoscopic treatment reduces the rebleeding rate, however, no simple method has been build to predict high risk of variceal rebleeding. We conducted this study to explore the value of the number of endoscopic sessions required to eradicate gastroesphageal varices in identifying high risk of rebleeding.
Consecutive cirrhotic patients received sequential endoscopic therapy between January 2015 and March 2020 were enrolled. Endoscopic treatment was performed every 1-4 weeks until the eradication of varices. The primary endpoint was variceal rebleeding.
A total of 146 patients were included of which 60 patients received standard therapy and 86 patients underwent sequential endoscopic treatment alone. The cut-off value of the number of sequential endoscopic sessions is 3.5 times. Variceal rebleeding was significant higher in patients with endoscopic sessions > 3 times versus ≤ 3 times (61.5% vs. 17.5%, p < 0.001). Variceal rebleeding of patients with endoscopic sessions ≤ 3 times was significant lower than patients with > 3 times in group of standard therapy (19.6% vs. 88.9%, p < 0.001) and endoscopic therapy (15.9% vs. 47.1%, p = 0.028) respectively.
The number of sequential endoscopic sessions required to eradicate the varices is related to the risk of variceal rebleeding in patients with cirrhosis. If three times of endoscopic treatment can not eradicate the varices, a more aggressive treatment such as TIPS should be seriously considered.
对失代偿期肝硬化患者进行风险分层以识别高危再出血患者尤为重要。在临床实践中，连续内镜治疗后彻底消除胃食管静脉曲张可降低再出血率，但尚未建立简单的方法来预测静脉曲张再出血的高危风险。本研究旨在探讨根除胃食管静脉曲张所需的内镜治疗次数来识别再出血高危的价值。
连续纳入 2015 年 1 月至 2020 年 3 月期间接受连续内镜治疗的肝硬化患者。内镜治疗每 1-4 周进行一次，直到静脉曲张消除。主要终点为静脉曲张再出血。
共纳入 146 例患者，其中 60 例接受标准治疗，86 例单独接受连续内镜治疗。内镜治疗次数的截断值为 3.5 次。内镜治疗次数>3 次的患者再出血发生率明显高于≤3 次的患者（61.5%比 17.5%，p<0.001）。内镜治疗次数≤3 次的患者再出血发生率明显低于标准治疗组（19.6%比 88.9%，p<0.001）和内镜治疗组（15.9%比 47.1%，p=0.028）的患者。
根除静脉曲张所需的连续内镜治疗次数与肝硬化患者静脉曲张再出血风险相关。如果 3 次内镜治疗不能根除静脉曲张，应认真考虑更积极的治疗方法，如 TIPS。
