Clinical significance of isolated gastric varices in liver cirrhotic patients: A single‐referral‐centre retrospective cohort study

Abstract

Introduction Gastric varices (GVs) occur in 10–30% of liver cirrhotic patients, with a mortality rate of up to 45%. Rupture of isolated GVs (IGVs) is less prevalent but often results in more severe hemorrhage and a higher risk of mortality than rupture of esophageal varices (EVs). However, there is no clear consensus yet about the optimal management for incidentally discovered IGVs. Objective To determine the clinical significance of IGVs in liver cirrhotic patients. Methods This was a retrospective cohort endoscopy database study within a 2‐year period (2016–2017). All study subjects were liver cirrhotic patients with OVs or GVs. The exclusion criteria were noncirrhotic portal hypertension, presence of malignancy, absence of varices, and incomplete data. Statistical analysis was performed using IBM SPSS 23. Results A total of 153 patients were included in this study. IGVs were found in 13 (8.49%) patients, whereas OVs were found in 112 (73.20%) patients and gastro‐OVs were found in 28 (18.30%) patients. Child‐Pugh class C (CP C) score was the strongest independent risk factor for variceal bleeding in bivariate analysis (hazard ratio [HR]: 10.21, 95% confidence interval [CI]: 4.15–25.12, P = 0.001) and multivariate analysis (HR: 12.49, 95% CI: 4.95–31.54, P 0.001); however, the presence of IGVs was not an independent risk factor. CP C score was also the only significant risk factor associated with 1‐year mortality in liver cirrhotic patients on multivariate analysis (HR: 26.77, 95% CI: 6.01–119.34, P 0.001). Conclusion The presence of IGVs has no clinical significance in the occurrence of 1‐year rebleeding and in patient survival.

Managing liver cirrhotic complications: Overview of esophageal and gastric varices

“…CP class C was the only one found to be a risk factor for 1-year mortality in cirrhotic patients through multivariate analysis (HR, 26.77; 95% CI, 6.01-119.34; P =0.001). 72 Consistent with the previous study, the presence of high-risk varices was 80.60% in patients with CP class C, significantly higher compared to patients with CP class A (47.50%). EVL was done in 46.7% of patients; 33.6% of EVL during screening of varices, 39% after evaluation of previous EVL, and 27.4% due to AVB.…”

“…The use of platelet count/ bipolar spleen diameter ratio for detection of high-risk varices in compensated cirrhotic patients had area under the receiver operating characteristic curve of 0.77, sensitivity of 90.6%, and specificity of 58.3%. 74 A recent study by Lesmana et al 72 showed that EV was found in 73.20% of LC patients; meanwhile GOV and IGV were only found in 18.30% and 8.49%, respectively. Although GV is less prevalent than EV, patients with GV, particularly GOV, were associated with a greater risk for AVB.…”

“…Indications for EGD evaluation are screening for varices, evaluation of previous EVL, and AVB. [72][73][74] Challenges we face in managing EGV in Indonesia include lack of endoscopic facility/expertise and patients' reluctance to undergo EGD and/or HVPG due to its invasiveness. In resource-limited settings, non-invasive modalities to assess portal pressure or detect varices, such as TE, are also not available.…”

Comparison of Histoacryl® plus Lipiodol® versus Histoacryl® plus vitamin D3 in the management of isolated fundal varices: A retrospective comparative study

“…5,6 Gastric Varices have a poorer prognosis, as they result in a much heavier blood loss and a higher bleeding and thus higher mortalityrate. 4,7 In a large study which included 568 patients, initial endoscopy showed gastric varices in 20% of patients and 9% of patients developed gastric varices over a mean follow up of 24.6 ± 5.3 months, however, this was after eradication of esophageal varices and a mortality of 45% was reported. 5 Contrary to this a recent study reported the 6 weeks mortality of GV bleeding to be only 16.7%.…”