AI Article Synopsis
- The study examined the short-term effectiveness and safety of a combined endoscopic treatment (sclerotherapy and cyanoacrylate injection) paired with endoscopic variceal ligation (EVL) for treating gastric varices in liver cirrhosis patients.
- A total of 521 patients were analyzed, showing that the combined therapy significantly reduced early rebleeding rates in the emergency treatment phase compared to EVL alone but had similar outcomes in the secondary prophylaxis phase.
- Independent risk factors for early rebleeding included factors related to EVL treatment and discontinuation of non-selective beta-blockers after discharge, highlighting important considerations for patient management.
Article Abstract
Background: To explore the short-term efficacy and safety of endoscopic low dose injection of sclerotherapy and cyanoacrylate for gastric varices (GVs) combined with endoscopic variceal ligation (EVL) for esophageal varices (EVs) in cirrhosis with type GOV1 varices.
Methods: A total of 521 patients with cirrhosis and GOV1 varices, who were divided into emergence endoscopy treatment layer and secondary prophylaxis for rebleeding layer, were selected. All patients underwent combined therapy or EVL alone (ligation therapy) for the treatment of type GOV1 varices. The baseline between the two groups with significant differences were used as covariates for 1:1 propensity score matching. The early rebleeding rate was compared and the risk factors for rebleeding were identified in each layer.
Results: After propensity score matching, a total of 122 patients were included in the emergence endoscopy treatment layer, and 234 patients were included in the secondary prophylaxis layer. The early rebleeding rates in the combined therapy group vs. ligation therapy group was 4.92% vs. 16.39% (P = 0.04) and 2.56% vs. 1.71% (P = 0.65) in the emergency endoscopy layer and in the secondary prophylaxis layer, respectively. The median length of hospital stay after endoscopy was 8 days vs. 9 days (P = 0.004) and 7 days vs. 6 days (P = 0.47), in each layer respectively. There was no significant difference in the adverse reactions of endoscopic treatment. EVL treatment (OR: 3.84; 95% CI: 1.05-13.96; P = 0.04) and discontinuation of NSBB (non-selective beta-blocker) use after discharge (OR: 3.58; 95% CI: 1.20-10.67; P = 0.02) were independent risk factors for early rebleeding after endoscopy in the emergency endoscopy layer.
Conclusion: Combined therapy is comparable with ligation therapy in the short-term efficacy and safety of in cirrhosis patients with secondary prophylaxis for rebleeding while it is superior to EVL alone in cirrhosis in the emergency endoscopy treatment as it could reduce the early rebleeding rate and shorten the length of hospital stay.
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| http://dx.doi.org/10.1007/s00464-024-11393-7 | DOI Listing |
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