Predictors of endoscopic prophylaxis for rebleeding in esophageal varices combined type 2 gastroesophageal varices

Abstract

Background: Patients with decompensated cirrhosis and esophageal varices (EVs) combined with type 2 gastroesophageal varices (GOV2) are at risk of rebleeding after endoscopic prophylaxis. This study was performed to evaluate the preventive efficacy of endoscopic treatment in patients with EVs combined with GOV2, and to identify the risk factor of rebleeding. Methods: We performed a single-center, observational, retrospective study of hospitalized patients with EVs combined with GOV2. The biochemical examination results, demographics, endoscopic performance measures and treatment methods of patients undergoing endoscopic treatment were collected. All patients were observed for 1-year, or were loss to follow-up. The predictors of rebleeding were analyzed by logistic regression analysis.Results: A total of 124 patients underwent endoscopic treatment, including 2 (1.6%) patients in whom bleeding failed to cease and 19 (15.3%) patients who were lost to follow-up. A total of 103 patients were observed until 1 year, including 11 (10.7%) patients who experienced rebleeding. The results indicated that EVs+GOV2 with GOV1, age, prothrombin time (PT), bilirubin level, platelet count, Child-Pugh grade, and model for end-stage liver disease (MELD) score were associated with rebleeding at 1 year in patients with EVs combined with GOV2. Multivariate logistic analysis revealed that age, EVs+GOV2 with GOV1, bilirubin level, and PT were independent risk factors for rebleeding.Conclusion: Endoscopic treatment is effective as a preventive treatment in patients with EVs combined with GOV2. EVs combined with GOV1, older age, coagulation failure, and increased bilirubin levels should be given close attention due to their associations with rebleeding after endoscopic prophylaxis. GOV1 may have a negative effect in patients with EVs +GOV2.