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

Abstract

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.

Short and long term outcomes of Balloon-occluded Retrograde Transvenous Obliteration (BRTO) in gastric varices patients: A retrospective analysis

“…The median survival time of our patients was more than 69 months which was better than the results of the previous studies (23,25,26). The in-hospital mortality rate immediately after the procedure was also much lesser in our patients (5.5%) than in the recent study from Japan (8.0%) (26).…”

“…We found that the long-term survival rates of our patients were superior to that of a single-centre retrospective analysis that included 60 patients who received BRTO for gastric varices between December 2005 and September 2018, where the overall survival rate was 44.1% at ten years (23). The median survival time of our patients was more than 69 months which was better than the results of the previous studies (23,25,26). The in-hospital mortality rate immediately after the procedure was also much lesser in our patients (5.5%) than in the recent study from Japan (8.0%) (26).…”

Evaluation of the efficacy and safety of endoscopic band ligation in the treatment of bleeding from mild to moderate gastric varices type 1

“…However, for striated varicose veins (mild to moderate) with a diameter less than 1 cm, precise puncture and precise endoscopic injection are difficult because of the low vascular tone. Therefore, rebleeding is characterized by bleeding from a draining ulcer that can develop as a result of TAI[ 21 , 22 ]. On the basis of our clinical findings, EBLs prevent bleeding from glue-draining ulcers.…”