Hebei Key Laboratory of Gastroenterology, Department of Gastroenterology, Hebei Institute of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Scand J Gastroenterol. 2022 Dec;57(12):1509-1516. doi: 10.1080/00365521.2022.2094719. Epub 2022 Jul 6.
To determine the risk factors for emergency endoscopic variceal ligation (EVL) failure in acute variceal bleeding (AVB).
Data from 161 cirrhosis patients with oesophageal variceal bleeding who underwent emergency EVL treatment at the Second Hospital of Hebei Medical University from January 2018 to May 2021 were retrospectively analysed. Enrolled patients were divided into a successful treatment group and a failed treatment group. The variables studied were demographic, clinical, imaging, laboratory, and endoscopic data from the enrolled patients.
Of the enrolled patients, 19 patients experienced emergency EVL failure. Of these patients, nine underwent emergency endoscopic treatment again, six patients were treated with a Sengstaken-Blakemore tube for haemostasis and endoscopic treatment, four patients received drug therapy. The presence of portal vein thrombosis (PVT) in the failure group was higher than that in the success group ( < .05). Active bleeding on endoscopy was associated with emergency EVL failure for patients with Child-Pugh class C ( < .05).
Child-Pugh class C with active bleeding on endoscopy or the presence of PVT could increase the risk of emergency EVL failure. The patient's condition should be fully evaluated before emergency endoscopic treatment to reduce the risk of failure.
确定急性静脉曲张出血（AVB）患者行急诊内镜下套扎术（EVL）失败的危险因素。
回顾性分析 2018 年 1 月至 2021 年 5 月在河北医科大学第二医院接受急诊 EVL 治疗的 161 例肝硬化食管静脉曲张出血患者的数据。将纳入的患者分为治疗成功组和治疗失败组。研究的变量包括患者的人口统计学、临床、影像学、实验室和内镜数据。
在纳入的患者中，有 19 例患者出现急诊 EVL 失败。其中，9 例再次行急诊内镜治疗，6 例采用三腔二囊管止血加内镜治疗，4 例接受药物治疗。失败组门静脉血栓形成（PVT）的发生率高于成功组（<0.05）。Child-Pugh 分级为 C 级且内镜下有活动性出血的患者行急诊 EVL 失败的风险更高（<0.05）。
内镜下有活动性出血或存在 PVT 的 Child-Pugh 分级 C 级可增加急诊 EVL 失败的风险。在进行急诊内镜治疗前，应充分评估患者的病情，以降低失败的风险。
