Analysis of Prognostic Factors in Patients With Gastric Varices After Endoscopic Treatment

Wakatsuki, Takeru; Obara, Katsutoshi; Irisawa, Atsushi; Sakamoto, Hiroaki; Kuwana, Toshimitu; Takiguchi, Fujio; Saito, Ayako; Shishido, Hideo; Hikichi, Takuto; Oyama, Hitoshi; Shibukawa, Goro; Takagi, Tadayuki; Yamamoto, Go; Imamura, Hidemichi; Takahashi, Yuta; Sato, Ai; Satō, Masaki; Kasukawa, Reiji; Ohira, Hiromasa

doi:10.1111/j.1443-1661.2009.00898.x

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…However, the early and late rebleeding had no significant difference between the two groups in our study, which may be due to the consistent quality in performing the gastric variceal obliteration by a single endoscopist. Endoscopic treatment failure causing death was noticed in one patient (1.3%), which is compatible with previous reports 6,32,34,45,47 with the range of 0%e3.5% (Table 3). In our study, there were patients who died during the hospitalization (the mortality rate was 11.8%), which was similar to the previous report 35 of 10.3% in patients with gastric varices treated with N-butyl cyanoacrylate, and a wide range of mortality rate has been reported (3.7%e82.5% 14,45 ).…”

Section: Discussionsupporting

confidence: 92%

Gastric Variceal Bleeding in the Elderly

Wang

Chen

Lin

et al. 2012

International Journal of Gerontology

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s u m m a r yBackground: Upper gastrointestinal bleeding of all causes has a higher morbidity and mortality in older patients compared with younger patients. We retrospectively studied gastric variceal bleeding in older patients and compared the complications and outcomes of endoscopic variceal obliteration with younger patients. Methods: From August 2002 to August 2010, a total of 76 patients with gastric variceal bleeding who had received endoscopic variceal obliteration using Histoacryl as an adhesive agent by a single endoscopist were studied. Their chart records were obtained and reviewed with data collection. Patient demographics, laboratory parameters, etiology of liver cirrhosis, Child-Pugh classification, endoscopic findings, complications after endoscopic treatment, and mortality were gathered and analyzed. Results: A total of 26 (34.2%) of the 76 patients were older than 64 years. There were patients who were younger than 64 years who had more variceal bleeding as compared with the older patients. In older patient groups, women were more likely to have gastric variceal bleeding than their male counterparts. The most common type of gastric varices was gastroesophageal varices type 2 (GOV2). Significant difference existed in the etiology of cirrhosis between the two groups, with more hepatitis B and alcoholic hepatitis in the younger patients and more hepatitis C in the older patients. Significantly more Child-Pugh classification B and C cases were noticed in the younger patients. There were no significant differences of mortality and complications after treatment, including recurrent bleeding and sepsis, between the older and younger patients. Conclusion: There was no significant difference in outcomes after endoscopic treatment between the younger and the older patient groups. Endoscopic variceal obliteration using Histoacryl as an adhesive agent could be applied to treat older patients with gastric variceal bleeding just as it is for younger patients.

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Section: Discussionsupporting

confidence: 92%

Gastric Variceal Bleeding in the Elderly

Wang

Chen

Lin

et al. 2012

International Journal of Gerontology

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“…Therefore, EIS with cyanoacrylate (CA) has been used for the initial hemostasis in patients with FV [ 7 ]. However, FV frequently recur, leading to rebleeding, even if initial hemostasis has been successfully achieved by EIS with CA, as long as the blood supply from the gastrorenal shunt (GRS) remains [ 8 , 9 ]. In contrast, balloon-occluded retrograde transvenous obliteration (BRTO), which has been used in Japan as elective therapy for patients with FV showing blood supply through GRS, has seldom been shown to be followed by recurrence of FV bleeding [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices

et al. 2022

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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.

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“…[18][19][20][21][22] Modified Child Pugh Classification system is a good prognostic indicator that directly or indirectly commensurate with degree of decompensation. 23 Majority of patients in this study belonged to Child Class B followed by Child Class A and C respectively. The smaller percentage of Child Class C patients may be attributed to overall decreased 1year survival rate.…”

Section: Discussionmentioning

confidence: 79%

Decompensated Cirrhosis

Iqbal¹,

Yousaf²,

Yousuf³

et al. 2015

TPMJ

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Cirrhosis with subsequent portal hypertension is a major health problemworldwide. Among various etiologies, HCV is the leading cause of chronic hepatocellularinjury. Cirrhosis being the commonest cause of portal hypertension results in a spectrum ofcomplications. Approximately 5-15% of cirrhotic develop varices. Gastric varices althoughpresent less frequently as compared to esophageal varices but are associated with greatermortality and morbidity. Objectives: To determine prevalence of Gastric varices in patients withdecompensated cirrhosis. Study Design: Cross sectional study. Place & Duration: Carriedout at two centers, Pakistan Ordinance Factories Hospital Wah Cantt and Shalimar HospitalLahore from Jan 2014 to Jan 2015. Subjects: A total of 421subjects of decompensate cirrhosiswere included in the study. Methods: Patients with decompensate cirrhosis of any etiology whowere visiting the two hospitals as inpatient or outpatient were included in the study. Upper GIendoscopy was done in all these subjects for determination of gastric varices. Results: Among421 patients of decompensate cirrhosis, frequency of gastric varices was 10.9%, GOV1 as themost common variant. Gastric varices contributed to 5.4% of all variceal bleeds. Conclusion:Gastric varices are found in significant number of patients of decompensate cirrhosis. Sincegastric varices are associated with increased mortality and poor outcomes, these shouldbe carefully looked during upper GI endoscopy. Successful management of gastric varicealhemorrhage necessitates availability of expertise and newer diagnostic modalities.

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Analysis of Prognostic Factors in Patients With Gastric Varices After Endoscopic Treatment

Abstract: Grade B or C in Child-Pugh classification, emergency or elective situation, and association with hepatocellular carcinoma are negative prognostic factors after endoscopic treatment.

Cited by 9 publications

References 31 publications

Gastric Variceal Bleeding in the Elderly

Gastric Variceal Bleeding in the Elderly

Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices

Decompensated Cirrhosis

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