Hu Yihuan, Zhou Mei, Liu Deliang, Gong Jian
Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.
Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan Province, China.
Dig Dis Sci. 2025 Mar 31. doi: 10.1007/s10620-025-08999-9.
Glue extrusion bleeding is a major complication of endoscopic cyanoacrylate glue injection for the treatment of gastric varices. However, its risk factors remain unclear.
This retrospective study aimed to evaluate the risk factors for bleeding associated with glue extrusion.
This study analyzed the medical data of cirrhotic patients who underwent endoscopic obliteration for gastric varices using cyanoacrylate glue between January 2016 and December 2022. The data within 1 year after therapy were carried out with logistic regression. A nomogram model was constructed based on the factors.
269 patients were enrolled. Risk factors associated with glue extrusion bleeding included the volume of the glue (≥ 4 mL)(OR 1.289, 95% CI 1.051-1.580; P = 0.015), massive ascites (OR 5.645, 95% CI 2.260-14.097; P = 0.000), active hemorrhage during endoscopy (OR 2.830, 95% CI 1.284-6.234; P = 0.010), and the use of β-blockers was a protective factor (OR 0.185, 95% CI 0.07-0.485; P = 0.001). The nomogram model had good prediction accuracy, with an area under the curve of 0.74 (95% CI 0.658-0.822; P < 0.001).
Massive ascites, active hemorrhage during endoscopy, glue volume ≥ 4 mL, and the use of β-blockers are associated with glue extrusion bleeding. At-risk patients may benefit from controlling the volume of the glue, undergoing endoscopic ultrasound and using β-blockers.
胶水挤出性出血是内镜下注射氰基丙烯酸酯胶水治疗胃静脉曲张的主要并发症。然而，其危险因素尚不清楚。
这项回顾性研究旨在评估与胶水挤出相关的出血危险因素。
本研究分析了2016年1月至2022年12月期间接受内镜下使用氰基丙烯酸酯胶水闭塞胃静脉曲张的肝硬化患者的医疗数据。对治疗后1年内的数据进行逻辑回归分析。基于这些因素构建了列线图模型。
共纳入269例患者。与胶水挤出性出血相关的危险因素包括胶水用量（≥4毫升）（比值比1.289，95%置信区间1.051 - 1.580；P = 0.015）、大量腹水（比值比5.645，95%置信区间2.260 - 14.097；P = 0.000）、内镜检查时的活动性出血（比值比2.830，95%置信区间1.284 - 6.234；P = 0.010），而使用β受体阻滞剂是一个保护因素（比值比0.185，95%置信区间0.07 - 0.485；P = 0.001）。列线图模型具有良好的预测准确性，曲线下面积为0.74（95%置信区间0.658 - 0.822；P < 0.001）。
大量腹水、内镜检查时的活动性出血、胶水用量≥4毫升以及使用β受体阻滞剂与胶水挤出性出血有关。高危患者可能受益于控制胶水用量、进行内镜超声检查以及使用β受体阻滞剂。
