Risk factors associated with failure of endoscopic combined treatment to prevent varices rebleeding in patients with liver cirrhosis

ABSTRACT

Background

The aim of this study is to investigate risk factors associated with gastroesophageal variceal rebleeding after endoscopic combined treatment.

Research design and methods

Patients who had liver cirrhosis and underwent endoscopic treatment to prevent variceal rebleeding were retrospectively recruited. Hepatic venous pressure gradient (HVPG) measurement and CT examination of portal vein system were performed before endoscopic treatment. Endoscopic obturation for gastric varices and ligation for esophageal varices were performed simultaneously at the first treatment.

Results

One hundred and sixty-five patients were enrolled, and after the first endoscopic treatment, recurrent hemorrhage occurred in 39 patients (23.6%) during 1-year follow-up. Compared to the non-rebleeding group, HVPG was significantly higher (18 mmHg vs.14 mmHg, P = 0.024) and more patients had HVPG exceeding 18 mmHg (51.3% vs.31.0%, P = 0.021) in the rebleeding group. No significant difference was found in other clinical and laboratory data between two groups (P > 0.05 for all). By a logistic regression analysis, high HVPG was the only risk factor associated with failure of endoscopic combined therapy (OR = 1.071, 95%CI, 1.005–1.141, P = 0.035).

Conclusions

The poor efficacy of endoscopic treatment to prevent variceal rebleeding was associated with high HVPG. Therefore, other therapeutic options should be considered for the rebleeding patients with high HVPG.

KEYWORDS:

• gastroesophageal varices
• liver cirrhosis
• endoscopic treatment
• risk factor
• recurrent hemorrhage

Acknowledgments

We acknowledge the multidisciplinary team for the diagnosis and treatment of portal hypertension of Zhongshan Hospital affiliated to Fudan University.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers of this manuscript have no relevant financial or other relationships to disclose.

Abbreviations

TIPS, transjugular intrahepatic portosystemic shunt; HVPG, hepatic venous pressure gradient; CT, computed tomography; NSBBs, non-selective beta-receptor blockers; FHVP, free hepatic venous pressure; WHVP, wedged hepatic venous pressure; MIP, maximum intensity projection; GOV-1, type 1 gastroesophageal varices; GOV-2, type 2 gastroesophageal varices; IQR, interquartile range; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, international normalized ratio; MELD, model for end-stage liver disease.

Data availability statement

The participants in this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data are not available.

Author contributions

Conception and design of the work: Li F and Chen SY. Data collection: Wu L, Fang QQ, Huang XQ, Xue CY, and Rao CY. Data analysis and interpretation: Li F, Wu L, Fang QQ, Huang XQ, Luo JJ, Xu PJ, and Chen Y. Drafting the article: Li F. Critical revision of the article: Chen SY. All authors approved the final version of the article, including the authorship list.

Additional information

Funding

This work was supported by the Scientific Research Development Fund of Zhongshan Hospital affiliated to Fudan University (Grant NO. 2019ZSFZ09 to Li F).