Efficacy And Influencing Factors Of Endoscopic Treatment Of Esophageal And Gastric Varices

ObjectiveEsophageal and gastric variceal bleeding was the main cause of gastrointestinal bleeding,which was an emergency in gastroenterology.Endoscopic variceal ligation and Endoscopic injection sclerotherapy were used in the treatment of esophageal varices.Endoscopic "sandwich" therapy were used in the treatment of gastric varices.In this study,we collected retrospectively the clinical characteristics of patients with varices in two sites: esophagus and/or gastric,compared the efficacy of endoscopic treatment of esophageal and gastric varices through data analysis,and analyzed the factors influencing the efficacy of endoscopic treatment through statistical univariate and multivariate analysis to provide a basis for the prevention and treatment of esophageal and gastric varices.MethodsThe clinical data of patients who underwent endoscopic treatment of esophageal and gastric varices in cirrhosis between January 2015 and January 2023 at the First Hospital of Lanzhou University were retrospectively collected.Causes of cirrhosis(viral hepatitis,autoimmune liver disease,alcoholic liver disease,cholestatic liver disease,non-alcoholic fatty liver,etc.);laboratory-related tests(biochemistry,blood coagulation function,blood routine examination);radiological examinations:abdominal ultrasound(portal vein trunk internal diameter,splenic vein internal diameter,spleen size,abdominal water volume);abdominal CT scan(liver CT values,portal vein thrombosis,splenic vein thrombosis and superior mesenteric vein thrombosis);liver fibro scan;endoscopic findings(esophageal variceal diameter,esophageal veins with or without fusion,esophageal veins with or without red sign,esophageal veins with or without thrombus,gastric phlebangioma,fundic veins with or without fusion,gastric veins with or without red sign,gastric veins with or without thrombus)Results1.Baseline information:a total of 208 patients were included,208 cases with esophageal varices and 160 cases with gastric fundic varices.There were significant differences in albumin,globulin,prothrombin time,international standardized ratio,prothrombin activity,Child-Pugh score,liver CT value,presence of thrombus in the portal system,maximum diameter of esophageal varices,fusion of esophageal varices,red sign,thrombus,type of endoscopic treatment,and endoscopic diagnosis of portal hypertensive gastrointestinal disease among the three groups of patients with esophageal varices(P<0.05).There were statistical differences in globulin,red blood cell count,alcohol consumption,history of blood transfusion,anemia,gastric fundic phlebangioma,gastric fundic vein fusion,and gastric fundic vein thrombosis among the3 groups of patients(P<0.05).2.Esophageal varices occurred in all 208 cirrhotic patients,and the rates of variceal vein elimination after initial treatment,after 2 times of treatments,after 3 times of treatments,and after 4 times of treatments are 42.3%,76.4%,93.7%,and 100%,respectively.There were 160 patients with gastric varices,and the rates of variceal vein elimination after initial treatment,after 2 times of treatments and after 3 times of treatments were 69.4%,93.1% and 100%,respectively.3.Endoscopic hemostasis: there were 30 patients with esophageal variceal bleeding and 24 patients with gastric varices bleeding,and the success rate of endoscopic hemostasis was 100%.4.The complications of endoscopic treatment of esophageal varices include:esophageal stenosis,concurrent bleeding during treatment and delayed bleeding.There were 2 cases of esophageal stenosis and 2 cases of concurrent bleeding during treatment,both of which occurred in the sclerotherapy group.There was statistical difference in the treatment type and complications of esophageal varices.There was only 1 case of delayed bleeding after ligation treatment,and there was no significant difference compared with the other three groups.The treatment type of esophageal varices was not related to delayed bleeding.The complications of endoscopic treatment of gastric varices include: binder removal associated ulcer and delayed bleeding.Among the patients with gastric fundus varices,64 had binder removal associated ulcer,of which6 had delayed bleeding.5.Analysis of factors influencing the times of endoscopic treatment of esophageal varices: compared with the once treatment group,patients with larger esophageal varices,portal vein thrombosis,and portal hypertensive gastrointestinal disease were more likely to require twice treatment.Patients with lower prothrombin activity,higher liver CT values,and larger esophageal varices are more likely to require many times treatments.Compared to the 2 times of treatment,patients with lower globulin and higher liver CT values were more likely to require multiple treatments.6.Analysis of factors influencing the times of endoscopic treatment of gastric fundal varices:compared with the once treatment group,patients with gastric fundus phlebangioma and gastric fundus venous fusion were more likely to require twice treatment;patients with a history of blood transfusion,gastric fundus phlebangioma and venous fusion were more likely to require three treatments;compared to the 2 times of treatment groups,patients with a history of blood transfusion were more likely to require three treatments.Conclusion1.The incidence of esophageal varices is higher than gastric varices.2.Endoscopic hemostasis of ruptured esophagogastric variceal bleeding with high high efficiency and safety.3.Endoscopic variceal ligation,endoscopic injection sclerotherapy,and the "sandwich" therapy are safe and effective in eliminating esophageal varices.The "sandwich" therapy is safe and effective in eliminating gastric varices.4.The diameter of esophageal varices is an independent risk factor for the times of treatment,the presence of portal vein thrombosis and the presence of portal hypertensive gastrointestinal disease are independent risk factors for the need of two times of treatment,the CT value of the liver is an independent risk factor for the need of multiple treatments,and the prothrombin activity is an independent protective factor for the need of multiple treatments.5.The presence of phlebangioma and fused varices in the gastric fundus is independent risk factors for the times of treatment of gastric fundic varices,and a history of blood transfusion is an independent risk factor for the need of three times of treatment.