Drugs Combined With Endoscopic Therapy Versus TIPS In The Management Of Variceal Bleeding In Cirrhotic Patients

BackgroundIn patients with cirrhosis,as the disease progresses to a decompensated period,the patient may have some signs related to portal hypertension,including ascites,opening collateral circulation,splenomegaly and hypersplenism.Among them,esophageal and gastric variceal bleeding is the most dangerous complication with the highest mortality.About 50.0% of cirrhotic patients can have gastroesophageal varices,and 5-15% patients will develop into esophageal and gastric variceal bleeding,the mortality rate was up to 20% within 6 weeks after the first hemorrhage.Current clinical treatment of esophageal gastric varices bleeding in cirrhotic patients include drug combined with endoscopy treatment,TIPS,surgery,balloon placement and so on.In recent years,with the development of endoscopy and interventional technology,drugs combined with endoscopic therapy and TIPS have been more and more used in cirrhotic patients with esophageal and gastric variceal bleeding due to their relatively small trauma and good therapeutic effect.The drugs combined with endoscopy treatment has already been widely used because of its less trauma and better treatment efficacy.In the early stage of TIPS,bare metal stents are often be used.Recently,with the application of covered stent,the curative efficacy of TIPS has been greatly improved.Therefore,the evaluation and choice of different treatment options for cirrhotic patients with esophageal and gastric variceal bleeding has become the focus of current research.ObjectiveTo compare treatment effect of drugs combined with endoscopic therapy(ET)and transjugular intrahepatic portosystemic shunt(TIPS)for esophageal and gastric variceal bleeding(EGVB)in cirrhotic patients,and provide reference for clinical treatment.MethodWe collected 120 cases of cirrhotic patients with esophageal and gastric variceal bleeding from January 2010 to December 2014 who underwent drugs combined with endoscopy therapy or TIPS surgery.According to the treatment method,77 cases were divided into the combined treatment group and 43 cases were divided into TIPS group.We collected the data retrospectively by referring to hospital records and telephone interviews.The acute hemostasis,rebleeding,survival,and complications were compared between the two groups.Result1.In general,the combined treatment group and the TIPS group had no statistically significant differences in age,sex,liver function grading,and etiology(P>0.05).2.For hemostasis in acute phase,the acute phase hemostasis rates in the combined treatment group and the TIPS treatment group were 96.1% and 97.7% respectively,and there is no significant difference in hemostasis rate between two treatment groups(P>0.05).3.For long-term efficacy,The cumulative 2-year bleeding rate in the combined treatment group was higher than that in the TIPS treatment group(P<0.05). There was no statistically significant difference in mortality between the two groups(P<0.05).10.4% vs 4.7%,P = 0.444).4.In terms of complications,the incidence of hepatic encephalopathy in the combined treatment group was lower than that in the TIPS treatment group,and the difference was statistically significant(13.2% vs 27.9%,P<0.05).During the follow up period.The incidence of esophageal stricture was 2.6% in combined treatment group.The incidence of stent stricture was 30.2 in TIPS group.ConclusionDrugs combined with endoscopy treatment and TIPS both have good hemostatic effect in the acute haemorrhage phase,and there is no significant difference in the survival time of the two group.Both treatments can be used as the first-line treatment for esophageal and gastric variceal bleeding in cirrhotic patients.Compared with drugs combined with endoscopic therapy,TIPS surgery can achieve better long-term bleeding control effect,but it will increase the incidence of hepatic encephalopathy.