中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 11
Nov.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(11): 2569-2574

Risk factors for rebleeding after endoscopic selective variceal devascularization in patients with hepatitis B cirrhosis and acute variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2021.11.017

  • Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

Research funding:

Capital Medical University Affiliated Beijing Ditan Hospital Young Talent Development Fund "Sprout" Project (DTMY201807);

Capital Foundation for Clinical Characteristic Applied Research Projects (Z181100001718084);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0404)

  • Received Date: 2021-03-23
  • Accepted Date: 2021-05-11
  • Published Date: 2021-11-20
    Abstract
  •   Objective  To investigate the rebleeding rate after endoscopic selective variceal devascularization (ESVD) and the predictive factors for rebleeding in patients with hepatitis B cirrhosis and esophageal variceal bleeding (EVB).  Methods  The patients with hepatitis B cirrhosis and EVB who attended Beijing Ditan Hospital, Capital Medical University, from October 2010 to December 2019 and underwent ESVD for the first time were enrolled, and a total of 442 patients were screened out based on inclusion and exclusion criteria. Routine clinical indices, laboratory markers, imaging findings, and endoscopic findings were compared between patients, and the patients were followed up to observe rebleeding. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to describe rebleeding and survival status, and a Cox regression analysis was used to determine the independent risk factors for variceal rebleeding.  Results  The 1-, 2-, 3-, 4-, and 5-year cumulative rebleeding rates after first ESVD treatment were 25.11%, 33.94%, 39.82%, 42.08%, and 45.02%, respectively. The univariate analysis showed that age, systolic pressure, duration of antiviral therapy ≥1 year, ascites, white blood cell count, neutrophil, and direct bilirubin were associated with rebleeding (all P < 0.05), and the multivariate analysis showed that duration of antiviral therapy ≥1 year (hazard ratio [HR]=0.504, 95% confidence interval [CI]: 0.357-0.711, P < 0.001) and ascites (HR=1.424, 95%CI: 1.184-1.714, P < 0.001) were independent influencing factors for variceal rebleeding.  Conclusion  ESVD has a low rebleeding rate in the treatment of hepatitis B cirrhosis with EVB, and presence of ascites and a short duration of antiviral therapy are independent risk factors for rebleeding after treatment.

     

    • FullText(HTML)
  • loading
    • References(22)
  • [1]
    GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906.
    [2]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.
    [3]
    MA JL, HE LL, LI P, et al. Prognosis of endotherapy versus splenectomy and devascularization for variceal bleeding in patients with hepatitis B-related cirrhosis[J]. Surg Endosc, 2021, 35(6): 2620-2628. DOI: 10.1007/s00464-020-07682-6.
    [4]
    MERCADO MA. Surgical treatment for portal hypertension[J]. Br J Surg, 2015, 102(7): 717-718. DOI: 10.1002/bjs.9849.
    [5]
    NETT A, BINMOELLER KF. Endoscopic management of portal hypertension-related bleeding[J]. Gastrointest Endosc Clin N Am, 2019, 29(2): 321-337. DOI: 10.1016/j.giec.2018.12.006.
    [6]
    de FRANCHIS R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63(3): 743-752. DOI: 10.1016/j.jhep.2015.05.022.
    [7]
    ZHENG J, PAN ZG, SU DX. Clinical effect of ESVD in treatment of portal hypertension and esophagogastric varices[J]. Int J Dig Dis, 2020, 40(5): 339-342. DOI: 10.3969/j.issn.1673-534X.2020.05.012.

    郑捷, 潘志刚, 苏东星. ESVD用于门脉高压食管胃静脉曲张破裂出血治疗的临床效果研究[J]. 国际消化病杂志, 2020, 40(5): 339-342. DOI: 10.3969/j.issn.1673-534X.2020.05.012.
    [8]
    LI P, WEI HS, JIANG Y, et al. Endoscopic selective varices devascularization: Effects of once endotherapy for esophageal and gastric varices[J]. J Inter Int Med, 2017, 23(4): 284-288. DOI: 10.11768/nkjwzzzz20170407.

    李坪, 魏红山, 蒋煜, 等. 精准贲门胃静脉曲张断流术: 一次性治疗食管胃连通型静脉曲张的近期疗效[J]. 内科急危重症杂志, 2017, 23(4): 284-288. DOI: 10.11768/nkjwzzzz20170407.
    [9]
    MA JL, JIANG Y, AI ZL, et al. Analysis of the prognosis and survival of patients undergoing endoscopic selective varices devascularization[J]. Mod Digest Interv, 2019, 24(6): 578-582. DOI: 10.3969/j.issn.1672-2159.2019.06.004.

    马佳丽, 蒋煜, 艾正琳, 等. 内镜下精准食管胃静脉曲张断流术患者预后及生存状况分析[J]. 现代消化及介入诊疗, 2019, 24(6): 578-582. DOI: 10.3969/j.issn.1672-2159.2019.06.004.
    [10]
    MA JL, HE LL, LI P, et al. Clinical features and outcomes of repeated endoscopic therapy for esophagogastric variceal hemorrhage in cirrhotic patients: Ten-year real-world analysis[J]. Gastroenterol Res Pract, 2020, 2020: 5747563. DOI: 10.1155/2020/5747563.
    [11]
    Spleen and Portal Hypertension Surgery Group, Chinese Medical Association of Surgery. Expert consensus on diagnosis and treatment of esophageal and gastric variceal hemorrhage in cirrhosis portal hypertension(2015)[J]. Chin J Pract Surg, 2015, 35(10): 1086-1090. DOI: 10.19538/j.cjps.issn1005-2208.2019.12.01.

    中华医学会外科学分会门静脉高压症学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2015)[J]. 中国实用外科杂志, 2015, 35(10): 1086-1090. DOI: 10.19538/j.cjps.issn1005-2208.2019.12.01.
    [12]
    MA JL, CHEN X, HONG S, et al. Metal clips combined with endoscopic histoacryl injection in the treatment of gastric varices with spontaneous portosystemic shunts (with video)[J]. Chin J Dig Endosc, 2020, 37(2): 111-114. DOI: 10.3760/cma.j.issn.1007-5232.2020.02.007.

    马佳丽, 陈旭, 洪珊, 等. 金属夹联合组织胶注射治疗胃静脉曲张伴自发性门体分流的临床研究[J]. 中华消化内镜杂志, 2020, 37(2): 111-114. DOI: 10.3760/cma.j.issn. 1007-5232.2020.02.007.
    [13]
    D'AMICO G, PAGLIARO L, BOSCH J. The treatment of portal hypertension: A meta-analytic review[J]. Hepatology, 1995, 22(1): 332-354. DOI: 10.1002/hep.1840220145.
    [14]
    CHEN J, ZENG XQ, MA LL, et al. Long-term efficacy of endoscopic ligation plus cyanoacrylate injection with or without sclerotherapy for variceal bleeding[J]. J Dig Dis, 2016, 17(4): 252-259. DOI: 10.1111/1751-2980.12331.
    [15]
    RÍOS CASTELLANOS E, SERON P, GISBERT JP, et al. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension[J]. Cochrane Database Syst Rev, 2015, 5: CD010180. DOI: 10.1002/14651858.CD010180.pub2.
    [16]
    ROCKEY DC. Liver fibrosis reversion after suppression of hepatitis B virus[J]. Clin Liver Dis, 2016, 20(4): 667-679. DOI: 10.1016/j.cld.2016.06.003.
    [17]
    GOYAL SK, DIXIT VK, SHUKLA SK, et al. Prolonged use of tenofovir and entecavir in hepatitis B virus-related cirrhosis[J]. Indian J Gastroenterol, 2015, 34(4): 286-291. DOI: 10.1007/s12664-015-0576-1.
    [18]
    HE L, YE X, MA J, et al. Antiviral therapy reduces rebleeding rate in patients with hepatitis B-related cirrhosis with acute variceal bleeding after endotherapy[J]. BMC Gastroenterol, 2019, 19(1): 101. DOI: 10.1186/s12876-019-1020-2.
    [19]
    BAMBHA K, KIM WR, PEDERSEN R, et al. Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis[J]. Gut, 2008, 57(6): 814-820. DOI: 10.1136/gut.2007.137489.
    [20]
    AMITRANO L, GUARDASCIONE MA, BENNATO R, et al. MELD score and hepatocellular carcinoma identify patients at different risk of short-term mortality among cirrhotics bleeding from esophageal varices[J]. J Hepatol, 2005, 42(6): 820-825. DOI: 10.1016/j.jhep.2005.01.021.
    [21]
    HOLSTER IL, TJWA ET, MOELKER A, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + β-blocker for prevention of variceal rebleeding[J]. Hepatology, 2016, 63(2): 581-589. DOI: 10.1002/hep.28318.
    [22]
    LV Y, QI X, HE C, et al. Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: A randomised controlled trial[J]. Gut, 2018, 67(12): 2156-2168. DOI: 10.1136/gutjnl-2017-314634.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(2)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (527) PDF downloads(45) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return