Open AccessLong-term outcomes of patients with cirrhosis presenting with bleeding gastric varices
Author(s) -
Masatoshi Nakazawa,
Yumiko Imai,
Kayoko Sugawara,
Yuzo Uchida,
Yoichi Saitoh,
Yohei Fujii,
Hiroshi Uchiya,
Satsuki Ando,
Nobuaki Nakayama,
Tomoaki Tomiya,
Satoshi Mochida
Publication year - 2022
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0264359
Subject(s) - medicine , gastric varices , gastroenterology , cirrhosis , varices , hepatocellular carcinoma , portal vein thrombosis , hemostasis , sclerotherapy , portal hypertension , surgery
Aim To establish a therapeutic strategy for cirrhosis patients with gastric variceal bleeding. Methods The outcomes of 137 patients with bleeding gastric varices were evaluated. Results The bleeding source was gastroesophageal varices (GOV) in 86 patients, and gastric fundal varices (FV) in 51 patients. The Child-Turcotte-Pugh classes were A, B, and C in 26, 79, and 32 patients, respectively; 34 patients (24.8%) had hepatocellular carcinoma (HCC), of which 11 also had complicating portal venous tumor thrombosis (PVTT). Patients with GOV were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with FV were treated by EIS with cyanoacrylate; 29 patients with FV also underwent additional balloon-occluded retrograde transvenous obliteration (BRTO). Hemostasis was successfully achieved in 136 patients (99.3%), and the cumulative 1-year, 3-year, and 5-year rebleeding rates were 18.1%, 30.8%, and 30.8%, respectively, in the patients with GOV, and 2.2%, 12.5% and 12.5%, respectively, in the patients with FV. The overall 1-year, 3-year, and 5-year survival rates were 79.7%, 71.5% and 64.4%, respectively, in the patients with GOV, and 91.0%, 76.9% and 59.5%, respectively, in the patients with FV. Multivariable analysis identified PVTT and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival. Conclusions Endoscopic therapies with or without BRTO appeared to be useful therapeutic strategies to prevent rebleeding in patients with gastric variceal bleeding, and favorable outcomes were obtained, except in patients with underlying HCC associated with PVTT and/or severe liver damage.