Risk factors of early re-bleeding and mortality in patients with ruptured gastric varices and concomitant hepatocellular carcinoma

Chang, Ching Hsun; Hou, Ming‐Chih; Liao, Wei‐Chih; Lee, Fa-Yauh; Lin, Han‐Chieh; Lee, Shou‐Dong

doi:10.1007/s00535-011-0518-3

Cited by 11 publications

(15 citation statements)

References 42 publications

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“…Furthermore, the long-term overall survival rate tended to be higher in the antibiotic group than in the nonantibiotic group. Although several studies have determined the prognostic factors for mortality in patients with GFV bleeding[ 4 , 20 ], only a few studies have reported antibiotic therapy as a favorable prognostic factor. In some studies, bacterial infection in patients with cirrhosis who developed bleeding was associated with early mortality and failure to control bleeding[ 21 ], and antibiotic therapy prevented rebleeding of both esophageal varices[ 22 , 23 ] and gastric varices[ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

Komori

Kubokawa

Ihara

et al. 2017

WJG

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AIMTo determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.METHODSIn total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients' medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results (hemoglobin, albumin, and bilirubin concentrations), and imaging results (including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality (up to 90 d) and long-term mortality in all patients.RESULTSMultivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95%CI: 0.01-0.52) and long-term mortality (OR = 0.27, 95%CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in short-term mortality (HCC: OR = 15.4, 95%CI: 2.08-114.75; PPI: OR = 12.76, 95%CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95%CI: 1.98-31.58; PPI: OR = 10.91, 95%CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI (P = 0.0074).CONCLUSIONAdministration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

Komori

Kubokawa

Ihara

et al. 2017

WJG

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“…[224243] In patients with GV, a presentation of active bleeding, carrying an associated diagnosis of HCC and a MELD score greater than 15 are poor prognostic factors found to be associated with a higher risk of GV rebleeding and both short and long-term mortality. [44] Two patients with GV on the background of having HCC were included in our cohort and responded well to NBCA treatment with no post-treatment bleeding observed till the time of this report. HVPG however, was not measured as an outcome in our study.…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single canadian tertiary care centre

Mosli

Al-Judaıbı

Almadi

et al. 2013

Saudi J Gastroenterol

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Background/Aim:Bleeding from Gastric Varices (GV) is not only life threatening, but also leads to many hospitalizations, contributes to morbidity and is resource intensive. GV are difficult to diagnose and their treatment can be challenging due to their location and complex structure. To assess the safety and efficacy of endoscopic gastric fundal variceal gluing using periodic endoscopic injections of N-butyl-2-cyanoacylate (NBCA) and to assess the utility of endoscopic ultrasound (EUS) in assessing for the eradication of GV post-NBCA treatment.Materials and Methods:Analysis of prospectively collected data of a cohort of patients with GV who underwent periodic endoscopic variceal gluing from 2005 to 2011. Outcomes included success of GV obliteration, incidence of rebleeding, complications from the procedure, and analysis of factors that might predict GV rebleeding. The success of GV eradication was assessed by both EUS and direct endoscopy.Results:The cohort consisted of 29 consecutive patients that had undergone NBCA injection for GV. The mean age was 60.8 years standard deviations (SD 13.3, range 20-81). The average follow-up was 28 months (SD 19.61, range 1-64) and the most common cause for GV was alcoholic liver cirrhosis (34.48%). A total of 91 sessions of NBCA injections were carried out for 29 patients (average of 3.14 sessions/patient, SD 1.79, range 1-8) with a total of 124 injections applied (average of 4.28 injections/patient, SD 3.09, range 1-13). 24 patients were treated for previously documented GV bleeding while five were treated for primary prevention. Overall, 79% of patients were free of rebleeding once three sessions of histoacryl® injection were completed. None of the patients treated for primary prevention developed bleeding during follow-up. 11 of the 24 patients (46%) with previous bleeding however had rebleeding. 4/11 (36%) patients had GV rebleeding while awaiting scheduled additional NBCA sessions. 19/29 (60%) patients had complete eradication of GV, 11/19 (58%) documented by endoscopic assessment alone, 4/19 (21%) by EUS alone and 4/19 (21%) by both techniques. Two of the 11 (18%) patients that had rebleeding had recurrence of GV bleeding after documented eradication by EUS compared to 5/11 (45%) patients documented eradication by endoscopic assessment and 2/11 (18%) patients that had rebleeding after documented eradication by both modalities. Twenty five patients in total had documented residual GV by EUS (14, 56%), direct endoscopic assessment (18, 72%) or both modalities (9, 36%), two of which developed recurrent bleeding (13%). No immediate or long-term complications of NBCA injection occurred, nor any related endoscopic complications were reported in any of these cases during the time of follow-up.Conclusion:NBCA injection of GV is a safe and successful therapeutic intervention. A minimum of three endoscopic sessions is required to significantly decrease the risk of bleeding/rebleeding. In this small sample of patients, neither EUS nor direct endoscopic assessment was reliable in p...

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“…According to a study of associated diagnosis of hepatocellular carcinoma (HCC), a high model for end-stage liver disease (MELD) score, advanced stage of the tumor, and increased level of alanine transaminase are poor prognostic factors and associated with a higher risk and both short-and long-term mortality [10].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Bleeding Gastric Varices by Endoscopic Cyanoacrylate Injection: A Developing-country Perspective

Mansoor-Ul-Haq

Latif

Asad

et al. 2020

Cureus

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Risk factors of early re-bleeding and mortality in patients with ruptured gastric varices and concomitant hepatocellular carcinoma

Cited by 11 publications

References 42 publications

Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

The safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single canadian tertiary care centre

Treatment of Bleeding Gastric Varices by Endoscopic Cyanoacrylate Injection: A Developing-country Perspective

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