Comparison On The Long Curative Effects Of Transjugular Intrahepatic Portosystemic Shunt And Endoscopic Cyanoacrylate Injection In The Treatment Of Gastric Variceal Bleeding

Objective : One of the most serious complications of liver cirrhosis and portal hypertension is gastric variceal bleeding.Although,the rate of gastric variceal bleeding is significantly lower than that of esophageal variceal bleeding,but is usually more severe,great amount of bleeding and is associated with higher mortality.As present,Endoscopic gastric variceal obturation(GVO)with an injection of 2-OCA is the currently recommended in recent consensus and guidelines as the initial treatment for acute gastric variceal bleeding,It has a high hemostasis rate,and it is effective to control the rupture of gastric veins.However,some studies have shown that there is a higher rebleedig rate after endoscopic tissue adhesive injection.and intravascular injection of tissue adhesive has the risk of ectopic embolism.Transjugular intrahepatic portosystemic shunt(TIPS)has been proven to be a effective means of gastric varices,which can reduce the portal venous pressure and significantly control gastric variceal rebleeding,and covered stents for TIPS can decrease the incidence of stent stenosis.But its long-term clinical efficacy needs to be further studied.There have some differences between transjugular intrahepatic portosystemic shunt and endoscopic treatment with cyanoacrylate in treatment of gastric variceal bleeding.Thus,the study is aimed to compare the long-term efficacy,survival rate and complications of transjugular intrahepatic portosystemic shunt and endoscopic gastric variceal obturation(GVO)with an injection of 2-OCA for gastric variceal bleeding,and to provide clinical data for optimum treatment method of gastric variceal rebleeding.Methods: Sixty-five cirrhotic patients admitted to the first affiliated hospital of anhui medical university between June 2014 to June 2016 due to gastric variceal bleeding who received TIPS or endoscopic gastric variceal obturation were included in our study.There were 28 cases in TIPS group,and there were 37 cases in GVO group.B ultrasonography and endoscopic were performed before and after the procedures to understand the width of portal vein and varicose veins in two groups,and the stent patency was assessed in the TIPS group.After the surgery,we followed up of all patients by outpatient and telephone,and recorded whether the two groups had bleeding,bleeding time and cause,whether the two groups had death,death time and cause,and complications.Then we compared the success rate,survival rate and complications of the two groups.We analyzed the cumulative incidence of unbleeding in 1and 2 years respectively for two groups by using the Kaplan-Meier estimation,and the log-rank test was used for comparison among groups.Results:Two groups of surgery were successful.The mean follow-up duration of TIPS treatment group was 20.18 months±6.90 months,and the mean follow-up duration of GVO treatment group is 16.14 months±6.03 months.1.There was no statistical difference in the width of the portal vein in the two groups during the pre-operation.The width of the portal vein in TIPS group was significantly reduced after the operation,which was significantly different from the pre-operative period(t = 2.605,P =0.015).The width of the portal vein in GVO group was no significant differrnce after operation.2.In TIPS treatment group,rebleeding occurred in 5(17.86%)patients,and in GVO treatment group,rebleeding occurred in 16(43.24%)patients.The rebleeding rates of the two groups had a significant difference(?2 = 4.697,P =0.03).The cumulative rebleeding-free rates at 6,12 and 18 months were 88.4%,83.7% and 76.1%,respectively,in the TIPS group,and the cumulative rebleeding-free rates at 6,12 and 18 months were 86.5%,70.2% and 60.9%,respectively,in the GVO group(P = 0.012).3.In TIPS treatment group,2(7.14%)patients died.In GVO treatment group,5(13.15%)patients died.The mortality rates of the two groups were 7.14% and 13.15%,respectively.The survival rates of the two groups had no significant difference(P = 0.69).4.There were 15 cases of complications in TIPS treatment group,and there were 22 cases of complications in GVO treatment group.There was no statistically significant difference in the incidence of complications between the two groups(?2 = 2.225,P =0.801).Conclusions:From the long-term curative effect analysis of two years,TIPS is superior to endoscopic 2-OCA injection for controlling gastric variceal bleeding because of effectively reducing portal vein pressure and decreseing the incidence of rebleeding.