| Objective:Esophagogastric varices bleeding(EGVB)due to portal hypertension in liver cirrhosis is the main cause of gastrointestinal bleeding.Once esophagogastric variceal bleeding occurs,the bleeding volume is often large and the mortality rate is high,which is a life-threatening gastroenterology emergency.Referring to domestic and foreign guidelines,the following recommendations are made for endoscopic treatment of EGVB:for simple esophageal variceal bleeding,endoscopic ligation and(or)sclerotherapy are recommended for treatment;for gastric variceal bleeding,endoscopic tissue glue injection is the first choice;for esophageal and gastric variceal bleeding,the combination of the above three methods is recommended.Because gastric variceal bleeding is more critical and dangerous,the treatment program is unclear,and there are fewer studies.Therefore,to explore the efficacy and safety of tissue glue injection more comprehensively,this study retrospectively analyzed two types of gastric varices patients including GOV2 and IGV1,and compared the two tissue glue injection regimens in the treatment of gastric varices through data analysis,univariate and multivariate analysis are used to analyze the risk factors for rebleeding,to provide more data for future clinical practice.Methods:A retrospective study of gastroesophageal varices type 2(GOV2)and isolated gastric varices type 1(IGV1)bleeding caused by liver cirrhosis admitted to the First Affiliated Hospital of Nanchang University from January 1,2014,to December 31,2019.Retrospectively collected the basic data(age,gender,active bleeding at admission or previous gastric varices bleeding,etc.)and clinical characteristics(pre-treatment test and inspection indicators)of 537 patients who were treated under the endoscopy.They were divided into the traditional group and the new group.191patients in the traditional group were given the traditional tissue glue injection method(lipiodol-tissue glue-lipiodol);346 patients in the new group were given the modified tissue glue injection method(polyurethane-tissue glue-lauryl alcohol).Repeat endoscopy within 3 months,and SPSS 23.0 version was used for statistical analysis to compare the success rate of hemostasis,gastric varices elimination rate within 3 months,early postoperative complications(fever,ectopic embolism,rebleeding,abdominal pain,sepsis or bacteremia,hepatic encephalopathy,death,etc.),and the COX proportional hazards model was used to analyze the risk factors for variceal rebleeding.Results:1.Baseline situation.The study involved 537 participants,191 in the traditional group and 346 in the new group.Baseline data between the two groups:gender,age,etiology of liver cirrhosis,splenomegaly,esophageal varices,emergency treatment,varices types(GOV2,IGV1),ascites,Child-Pugh grade classification,Child-Pugh score,MELD score,There were no significant differences in serum creatinine(Scr),total blood bilirubin(TB),international normalized ratio(INR),and prothrombin time(PT),serum albumin(Alb)were statistically different,stratified analysis of these factors had no effect on the outcome indicators.The two groups were comparable at baseline and were followed up for 3 months.2.Endoscopic treatment.There was a statistically significant difference in the amount of tissue glue used in the two groups(1.52±0.82 vs.1.11±0.70,P<0.001),the dosage of tissue glue in the new group was less than that in the traditional group;the average number of injection points in the new group was more than that in the traditional group(1.21±0.54 vs.2.76±1.47,P<0.001);The number of varicose treatment cases was more than that in the new group(91vs.47,P<0.001);the diameter of the gastric fundus vein in the traditional group was larger than that in the new group(2.95±1.21 vs.2.31±1.16,P<0.001).3.Complications.Postoperative complications of fever,ectopic embolism,and death in the traditional group were higher than those in the new group,but there was non-significant difference in abdominal pain,rebleeding within 72 hours,sepsis,and hepatic encephalopathy.During the follow-up period,1 patient in the traditional group underwent portal vein devascularization on the 8th postoperative day,4 patients underwent transjugular intrahepatic portosystemic shunt(TIPS),and 3 patients were diagnosed with primary hepatocellular carcinoma;In the new group,1 patient underwent postoperative TIPS,4 patients were diagnosed with primary hepatocellular carcinoma,and 5 patients underwent postoperative splenic artery embolization.4.Rebleeding.The successful hemostasis rates in the traditional group and the new group in the early postoperative period(within 72 hours)were 97.38%and 99.13%,respectively,and there was no significant difference between the two groups(P=0.218).The rebleeding rate was 4.71%in the traditional group and 3.76%in the new group.No evidence of a significant difference between the two groups in the rebleeding rate shown by the Kaplan-Meier curve of cumulative rebleeding free rate(Log-rank test,P=0.579).All-cause multivariate analysis showed that requiring emergency treatment(P=0.008)was an independent risk factor for rebleeding.Multivariate analysis in the traditional group showed that splenomegaly(P=0.01)and mild ascites(P=0.035)were independent risk factors for rebleeding.The new group multivariate analysis showed that requiring emergency treatment(P=0.042)and moderate to severe ascites(P=0.037)were independent risk factors for rebleeding.5.Survival situation.During the hospitalization observation and follow-up period after endoscopic treatment,a total of 14 patients died,including 9 deaths in the traditional group(4 cases of ectopic embolism,5 cases of hemorrhagic shock),and 5cases of death in the new group(1 case of sepsis,1 case of respiratory failure,2 cases of hemorrhagic shock,and 1 case of septic shock),the survival rate of the traditional group was 95.3%,and the survival rate of the new group was 98.6%.There was a statistically significant difference in survival between the two groups(χ~2=3.966,P=0.046).6.Elimination of gastric varices(GV).The patients lost to follow-up were excluded,and 383 patients were included for PP analysis.Most of the two groups were well matched at baseline.Comparing the elimination of gastric varices between the two groups,in the traditional group,31 cases were ineffective,39 cases were effective,and55 cases were markedly effective,and in the new group,56 cases were ineffective,38cases were effective,164 cases were markedly effective.The new group was better than the traditional group in GV elimination(P=0.003),but there was no significant difference in the total effective rate(effective rate+markedly effective rate)between the two groups(P=0.498).The curative effects of the two groups in the treatment of GOV2 patients with gastric fundus varices were compared,the traditional group was ineffective in 24 cases,effective in 34 cases,and effective in 45 cases,and the new group was ineffective in 48 cases,effective in 31 cases,and effective in 135 cases,there was a statistically significant difference in efficacy between the two groups(P=0.013),but there was no significant difference in the total effective rate between the two groups(P=0.862).The two groups were compared in the treatment of gastric fundus varices in patients with IGV1 type,the traditional group was ineffective in 7 cases,effective in 5cases,markedly effective in 10 cases,and the new group was ineffective in 8 cases,effective in 7 cases,and effective in 29 cases,there were no significant differences in efficiency and the total effective rate(P=0.110,P=0.213).Conclusion:1.Endoscopic modified tissue glue injection in the treatment of GOV2 and IGV1type esophagogastric varices is feasible and clinically safe and effective.2.Compared with the traditional tissue glue injection method(lipiodol-tissue glue-lipiodol),the modified tissue glue injection method(polyuric alcohol-tissue glue-polyuric alcohol)can reduce the amount of tissue glue during operation,cut down the postoperative fever rate and the occurrence of ectopic embolism,ameliorate the gastric varicose varices,improve the survival rate,without increasing the risk of rebleeding.3.Requiring emergency treatment and combined with moderate to severe ascites are independent risk factors for gastric variceal bleeding. |
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