Department of Gastroenterology, Digestive Disease Hospital, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.
Department of Gastroenterology, Guizhou Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guiyang 550000, Guizhou Province, China.
World J Gastroenterol. 2024 Feb 7;30(5):440-449. doi: 10.3748/wjg.v30.i5.440.
According to practice guidelines, endoscopic band ligation (EBL) and endoscopic tissue adhesive injection (TAI) are recommended for treating bleeding from esophagogastric varices. However, EBL and TAI are known to cause serious complications, such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI. However, the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage (GOV1) has not been determined. Therefore, the aim of this study was to discover an individualized treatment for mild to moderate GOV1.
To compare the efficacy, safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.
A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted. Patients were allocated to an EBL group or an endoscopic TAI group. The differences in the incidence of varicose relief, operative time, operation success rate, mortality rate within 6 wk, rebleeding rate, 6-wk operation-related ulcer healing rate, complication rate and average operation cost were compared between the two groups of patients.
The total effective rate of the two treatments was similar, but the efficacy of EBL (66.7%) was markedly better than that of TAI (39.2%) ( < 0.05). The operation success rate in both groups was 100%, and the 6-wk mortality rate in both groups was 0%. The average operative time (26 min) in the EBL group was significantly shorter than that in the TAI group (46 min) ( < 0.01). The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group (11.8% 45.1%) ( < 0.01). At 6 wk after the operation, the healing rate of operation-related ulcers in the EBL group was 80.4%, which was significantly greater than that in the TAI group (35.3%) ( < 0.01). The incidence of postoperative complications in the two groups was similar. The average cost and other related economic factors were greater for the EBL than for the TAI ( < 0.01).
For mild to moderate GOV1, patients with EBL had a greater one-time varix eradication rate, a greater 6-wk operation-related ulcer healing rate, a lower delayed rebleeding rate and a lower cost than patients with TAI.
根据实践指南，推荐使用内镜套扎（EBL）和内镜组织胶注射（TAI）来治疗胃食管静脉曲张出血。然而，EBL 和 TAI 已知会引起严重的并发症，如 EBL 引起的结扎环脱落导致的出血和 TAI 引起的与手术相关的溃疡出血。然而，对于轻度至中度 1 型胃静脉曲张出血（GOV1）的最佳治疗方法尚未确定。因此，本研究的目的是为轻度至中度 GOV1 发现一种个体化的治疗方法。
比较 EBL 和 TAI 治疗轻度和中度 GOV1 的疗效、安全性和成本。
对接受内镜治疗的轻度或中度 GOV1 胃静脉曲张患者的数据进行临床分析。患者被分配到 EBL 组或内镜 TAI 组。比较两组患者静脉曲张缓解率、手术时间、手术成功率、6 周内死亡率、再出血率、6 周手术相关溃疡愈合率、并发症发生率和平均手术费用的差异。
两种治疗方法的总有效率相似，但 EBL（66.7%）的疗效明显优于 TAI（39.2%）（<0.05）。两组的手术成功率均为 100%，两组的 6 周死亡率均为 0%。EBL 组的平均手术时间（26 分钟）明显短于 TAI 组（46 分钟）（<0.01）。EBL 组术后延迟再出血率明显低于 TAI 组（11.8% 45.1%）（<0.01）。术后 6 周，EBL 组手术相关溃疡愈合率为 80.4%，明显高于 TAI 组（35.3%）（<0.01）。两组术后并发症发生率相似。EBL 的平均成本和其他相关经济因素均高于 TAI（<0.01）。
对于轻度至中度 GOV1，EBL 治疗的患者一次性静脉曲张消除率更高，6 周手术相关溃疡愈合率更高，延迟再出血率更低，成本更低。
