Analysis Of The Timing Of Endoscopic Treatment For Esophagogastric Variceal Bleeding In Cirrhosis

Background:Esophagogastric variceal bleeding(EGVB)is a major life-threatening complication of decompensated cirrhosis and a common emergency of digestive system.At present,endoscopic therapy is the main clinical treatment for the control of EGVB,but the choice of timing of endoscopic examination is still controversial among experts,and few literatures have reported the factors affecting the clinical outcome of patients with EGVB in cirrhosis..Objective:The purpose of this study was to investigate the relationship between the timing of endoscopic examination and clinical outcome in patients with EGVB of cirrhosis,and to analyze the risk factors affecting rebleeding after endoscopic therapy.Methods:A retrospective analysis was performed on the clinical data of all patients who met the inclusion and exclusion criteria for EGVB due to cirrhosis undergoing endoscopic treatment in the Department of Gastroenterology,The First Affiliated Hospital of Nanchang University from January 2019 to June 2020.1.According to the time from admission to endoscopy,EGVB patients were divided into emergency endoscopy group(≤12h)and non-emergency endoscopy group(> 12h),and the baseline data and clinical outcomes of the two groups were analyzed and compared.2.Patients in the two groups with endoscopy duration ≤12h and > 12 h were matched with 1:1 propensity score matching(PSM),and the baseline data and clinical outcomes after PSM were analyzed and compared.3.Logistic regression model was used to conduct univariate and multivariate analyses of all the included patients to determine the risk factors for 30-day rebleeding and death after endoscopic treatment.Results:1.This study included 456 patients with EGVB of cirrhosis.There were statistically significant differences in baseline characteristics of hematemesis symptoms,heart rate,albumin,prothrombin time,international standardized ratio,treatment methods,CTP score,MELD score and Glasgow-Blatchford score between emergency endoscopy group(≤12h)and non-emergency endoscopy group(> 12h)(P< 0.05).There was no statistical significance in 30-day rebleeding and 30-day death in the two groups(P > 0.05).2.A total of 456 patients with EGVB of cirrhosis were matched by 1:1propensity score,and 266 patients were included,including 133 patients in the emergency endoscopy group(≤12h)and 133 patients in the non-emergency endoscopy group(> 12h),respectively.There was no statistical significance in baseline characteristics of the two groups(P > 0.05).The 30-day rebleeding rate in the emergency endoscopy group was significantly higher than that in the non-emergency endoscopy group(15% vs 6.8%;P=0.003),but there was no significant difference in 30-day mortality between the two groups(3% vs.3.8%;P =0.736).3.Multivariate Logistic regression analysis showed that age and shock at admission were independent risk factors for 30-day rebleeding and death in patients with EGVB of cirrhosis.Conclusions:1.The 30-day rebleeding rate of patients with EGVB cirrhosis treated with emergency endoscopy was significantly higher than that treated with non-emergency endoscopy,but there was no significant difference in 30-day mortality between the two groups.2.Age and shock at admission were independent risk factors for 30-day rebleeding and death in patients with EGVB of cirrhosis.