Modern strategies for the treatment and prevention of bleeding from gastric

Abstract

Aim. To analyze the results of modern prevention and treatment strategies applied for bleeding from gastric varices in patients with portal hypertension syndrome.Materials and methods. The study enrolled 276 patients with portal hypertension, including 187 cases of liver cirrhosis and 89 cases of extrahepatic portal hypertension. 24% of the patients with liver cirrhosis were classified as Child-Turcotte-Pugh Class A, 50% as Class B, and 26% as Class C. The portal vein thrombosis was confirmed in 80% of extrahepatic portal hypertension cases, while isolated splenic vein thrombosis was observed in 20%. Varices GOV1 (Sarin classification) were identified in 126 patients (45.7%), GOV2 in 110 patients (39.8%), and IGV-1 in 40 patients (14.5%). The following interventions were performed: endoscopic ligation, endoscopic sclerotherapy, endovascular techniques (transjugular intrahepatic portosystemic shunt, balloon-occluded retrograde transvenous obliteration), laparoscopic gastric devascularization, and distal splenorenal anastomosis.Results. Following endoscopic procedures, recurrence of gastric varices was noted in 20% of cases, and bleeding occurred in 7%. The efficacy of endoscopic treatment amounted to 71%; endoscopic ligation for bleeding from GOV1 varices appeared effective in 94.4% of cases. Early recurrence of bleeding developed in 29.4% of patients. The efficacy of endoscopic sclerotherapy for bleeding from GOV2/IGV1 varices comprised 96.7% with early recurrence occurring in 12.9% of patients. The secondary prevention involved multiple endoscopic interventions that led to complete eradication of gastric varices in 34% of cases with recurrent bleeding noted in 9.3% of patients, while persistent recurrence of gastric varices was observed in 66%. A splenorenal anastomosis provided reliable prevention of recurrent bleedings. No shunt thrombosis or mortality was recorded; however, the incidence of post-shunt encephalopathy comprised 16.5%. Transjugular intrahepatic portosystemic shunt facilitated a significant reduction in portal pressure and the enlargement of esophageal and gastric varices. Post-shunt encephalopathy occurred in 48.6% of patients. In the long-term follow-up, a recurrence of esophagogastric bleeding was recorded in one patient. Laparoscopic azygoportal disconnection contributed to the regression of varices in the esophagus and stomach; however, a recurrence of gastric varices developed in 30% of cases and a recurrence of bleeding in 12.5%.Conclusion. Current medicine obtains a sufficient arsenal of modern methods for the treatment and prevention of bleeding from gastric varices. The choice of treatment and prevention strategies for bleeding in portal hypertension necessitates a differentiated approach, taking into account the etiology and degree of disease decompensation.