Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data

Abstract

Background/AimsWhile gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea.MethodsThe data of 1,308 episodes of GVB (males:females=1062:246, age=55.0±11.0 years, mean±SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated.ResultsThe initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001).ConclusionsThe clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.

Balloon‐occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: A meta‐analysis

“…1 To date, the bleeding of gastric varices remains to be a tough problem, which was full of challenges. [2][3][4] Transjugular intrahepatic portosystemic shunt (TIPS), acted as a mini-invasive interventional surgery, has a good effect on the therapy of gastric and esophageal varices, and consequently has been widely used in the last several decades, especially for the patients who did not have a good state and other treatments was not suitable for.…”

The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

“…Recently, many studies show that GVO is more effective and safer than endoscopic gastric variceal sclerotherapy and ligation in the management of acute GVB 26-29. Also, Mahadeva et al have reported that GVO was more cost effective than TIPS in the management of acute GVB 30.…”

“…Also, among the many related factors, the Child-Pugh score and MELD score were significantly associated with mortality. Kim et al have reported that the Child-Pugh score and MELD score contributed to predicting survival of the patients with GVB 29,32. This suggests that important factors in predicting the prognosis of GVB are the severity of cirrhosis.…”

Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices

“…BRtO and modified-BRtO (mBRtO using coil or vascular plug instead of balloon) are receiving increased attention for the management of bleeding gastric varices [6][7][8] . BRTO has a high efficacy in stopping acute gastric variceal bleeding and has shown to have a signifi cantly lower re-bleeding rate of gastric varices compared to tIPS or endoscopic treatment [9][10][11][12][13][14] . Recently, our group has shown the effectiveness of mBRtO using coils or vascular plugs in place of balloons [15][16][17] , which is comparable to conventional BRtO [8][9][10][11][12]18,19] .…”