[Outcomes of Endoscopic Treatment of Esophagogastric Variceal Bleeding and Construction and Validation of a 1-Year Rebleeding Risk Prediction Model].

OBJECTIVE

To explore the efficacy of endoscopic therapy for esophageal and gastric variceal bleeding (EGVB), investigate the risk factors for rebleeding within 1 year, and establish a predictive model accordingly.

METHODS

A retrospective study was conducted using the clinical and follow-up data of 120 EGVB patients who underwent endoscopy at our hospital between January 2021 and December 2022. The efficacy of endoscopic therapy was analyzed, and the patients were divided into a bleeding group and a non-bleeding group based on whether rebleeding occurred within 1 year after treatment. The factors influencing rebleeding within 1 year after treatment were analyzed, and a predictive model was established using logistic regression analysis. The model's goodness of fit was evaluated using the Hosmer-Lemeshow test, and its clinical value was analyzed using the receiver operating characteristic (ROC) curve.

RESULTS

The hemostasis success rate within 72 hours after endoscopic therapy was 100% in all 120 patients. Four weeks after endoscopic treatment, endoscopic reexamination showed that the complete and partial disappearance rate of varices was 75.83% (91/120), with rebleeding occurring in 10 cases (8.33%). There were 34 cases (28.33%) of cumulative rebleeding at 6 months and 63 cases (52.50%) at 1 year after endoscopic therapy. Nine patients (7.50%) died within 1 year after endoscopic therapy, all of whom were rebleeding cases. A total of 63 patients with rebleeding were included in the bleeding group, and 57 patients without rebleeding were included in the non-bleeding group. Serum sodium < 135 mmol/L (odds ratio [OR] = 3.837, 95% confidence interval [CI]: 1.095-13.445), Child-Pugh grade C (OR = 3.835, 95% CI: 1.137-12.935), esophageal varices degree G3 (OR = 5.113, 95% CI: 1.565-16.707), and main portal vein diameter > 12 mm (OR = 5.964, 95% CI: 2.295-15.497) were identified as risk factors of rebleeding within 1 year after endoscopic therapy in EGVB patients ( < 0.05). The risk prediction model for rebleeding within 1 year after endoscopic therapy in EGVB patients was shown as P = 1/{1+e}. The Hosmer-Lemeshow was 3.158 ( = 0.856). The area under the curve (AUC) for predicting rebleeding within 1 year after endoscopic therapy in EGVB patients was 0.815, indicating good predictive performance. Clinical validation showed that the model had an accuracy of 82.30%, with sensitivity and specificity being 81.03% and 83.63%, respectively.

CONCLUSION

Endoscopic therapy for EGVB achieves a high rate of acute bleeding control, but patients remain at risk of rebleeding. Rebleeding is associated with serum sodium < 135 mmol/L, Child-Pugh grade C, main portal vein diameter > 12 mm, and esophageal varices degree G3. The logistic regression model can effectively predict the probability of rebleeding within 1 year after endoscopic therapy.