Analysis Of Endoscopic Efficacy And Prognosis Of The Elderly With Severe GOV1 Gastroesophageal Varices

Objective:1.To investigate the endoscopic detection rate and the changing trend of type 1 gastroesophageal varices(GOV1)at our hospital in recent 10 years,To determine the proportion and the trend of the elderly and non-elderly patients with GOV1 gastroesophageal varices each year and the severity of the varices in the elderly patients with GOV1 gastroesophageal varices.2.To evaluate the efficacy of different endoscopic treatment of severe GOV1 gastroesophageal varices in elderly patients in secondary prophylaxis group and acute variceal bleeding group.3.To explore the factors on the prognosis of the elderly with severe GOV1 gastroesophageal varices.Methods:A retrospective study of patients,who were admitted to our hospital from January 1st 2008 to December 31 st 2017,receiving initial endoscopic examination and therapy for GOV1 gastroesophageal varices in elderly patients with liver cirrhosis,was conducted.Patients were followed up until December 31 st 2018 or patients death.The study aims to analyse the detection rate of GOV1 gastroesophageal varices in elderly patients at our hospital in recent 10 years,compare the endoscopic efficacy in elderly patients with secondary prophylaxis group and acute variceal bleeding group and investigate the factors on the poor prognosis of the elderly with severe GOV1 gastroesophageal varices.Results:1.The detection rate of GOV1 gastroesophageal varices at our hospital was 0.01%-2.67% in recent 10 years.The detection rate of gastroesophageal varices increased year by year and reached 2.67% in 2017.The average age of GOV1 patients with gastroesophageal varices was 50±12 years old,among 17% of the total cases were elderly patients.The variceal diameter in elderly patients with GOV1 gastroesophageal varices was 1.31±0.47 cm.The variceal diameter of about 79% of patients was 1.0-2.0cm2.In secondary prophylaxis group,the 6-week re-bleeding rate(9.43% vs 9.09%,P>0.999),the 6-week mortality(3.77% vs 0%,P>0.999),the 1-year re-bleeding rate(12.24% vs 27.27%,P = 0.427),the 1-year mortality rate(2.04% vs 9.09%,P = 0.336),and the total mortality rate(35.29% vs 9.09%,P = 0.177)between esophageal variceal ligation(EVL)group and esophageal variceal injection(EVI)group in the elderly with severe gastroesophageal varices had no difference(P > 0.05).3.In acute variceal bleeding group,the immediate hemostasis rate(98.81% vs 100%,P>0.999),the 6-week re-bleeding rate(8.43% vs 25.00%,P=0.178),6-week mortality rate(3.61% vs 12.50%,P = 0.312),1-year re-bleeding rate(21.05% vs 14.29%,P>0.999),1-year mortality rate(6.58% vs 14.29%,P = 0.421),total mortality rate(34.67% vs25.00%,P=0.876)were also no obvious difference between esophageal variceal ligation group and esophageal variceal injection group in the elderly with severe GOV1 gastroesophageal varices.4.COX multivariate analysis indicated 67 year-old patients,moderate and severe ascites on admission were independent risk factors of re-bleeding within 6 weeks after endoscopic treatment in the elderly with severe GOV1 gastroesophageal varices.The INR>1.42,moderate and severe ascites,combining with diabetes were the independent risk factors of death in the elderly with severe GOV1 gastroesophageal varices.Conclusions:1.The detection rate of GOV1 gastroesophageal varices at our hospital was 0.01%-2.67% in recent 10 years.2.The endoscopic efficacy of the elderly with severe gastroesophageal varices in secondary prophylaxis group between esophageal variceal ligation group and esophageal variceal injection group was similar.There was no significant difference between the two groups.3.The endoscopic efficacy of the elderly with severe gastroesophageal varices in acute variceal bleeding group between esophageal variceal ligation group and esophageal variceal injection group was similar.There was no significant difference between the two groups.4.COX multivariate analysis indicated 67 year-old patient,moderate and severe ascites on admission were independent risk factors of re-bleeding within 6 weeks after endoscopic treatment.The INR>1.42,moderate and severe ascites,combining with diabetes were the independent risk factors of death.