| OBJECTIVEOur purpose was to explore the efficacy of on-demand endoscopic treatment ofesophagogastric varices in portal hypertensive patients, as well as the efficacy ofadhesive-sclerosant mixature therapy of gastric varices.METHODS375upper gastrointestinal bleeding patients confirmed esophagogastric varices byundergoing enoscopy in Shanghai Ruijin Hospital or Ruijin Hospital North affiliated toShanghai Jiaotong University School of Medicine during Oct2006to July2013wereinvolved as research group, who were treated by endoscopic methods such as endoscopicvariceal ligation (EVL),endoscopic sclerotherapy and adhesive-sclerosant mixaturetherapy according to the different type and degree of varices.69cases free of endoscopictreatment were involved as control group. According to the compliance of patients inrepeating endoscopy and eradicaion therapy within regular intervals,375cases weredivided into327cases of on-demand group and48cases of regular group. The time offirst and second episode of bleeding was recorded and the intervals were compared. Theendoscopic appearance, the variceal eradication rates, the rebleeding rates and motalityrates were also compared.For the84cases of gastric varices undergone endoscopic adhesive-sclerosantmixature therapy, the frequencies of bleeding, portal hypertensive gastropathy before andafter the treatment were recorded and compared.The variceal eradication, the number ofstep-surgery patients and mortality rates were also recorded. RESULTSThe mean times of treatment was1.65(1~11) in on-demand group and3.54(2~11) inregular group(P<0.001). The variceal eradication or nearly-eradication rates of on-demandgroup and regular group were87.5%and100%(P=0.232), respectively. In control group,the rebleeding rates were34.78%in6months,15.94%in6~12months and7.27%in12~24months. In research group, the rebleeding rates were15.57%in6months,7.65%in6~12months and5.46%in12~24months, which were lower than the control groupwithout endoscopic treatment(P<0.001). Comparison of Kaplan-Meier estimates ofnon-rebleeding time showed statistical differences between69cases of control group and375cases of research group(P<0.001), and the non-rebleeding rate of the control groupwas lower. The non-rebleeding rate of the regular group was higher than that ofon-demand group, but it showed no statistical differences(P=0.174). The non-rebleedingrate of the control group was lower than that of on-demand group with statisticaldifferences(P<0.001). Comparison of Kaplan-Meier estimates of time to death showed nostatistical differences between on-demand group and regular group(P=0.184).The bleeding frequencies before and after the endoscopic adhesive-sclerosantmixature therapy in84cases were0.72(0.06~2.50)/month and0.31(0~5.00)/month(P<0.001）, respectively. The eradication or nearly-eradication rate was83.4%.15caseshad surgery or radiologic therapies afterwards, and no rebleeding episode was recorded inthe follow-up period(mean28.3months). Despite that2patients died of massiverebleeding during the short period after endoscopic treatment, no severe complicationshappened. The total mortality rate of this group was34.2%.26cases died in meanfollow-up of25.9(0.2~76) months. The causes of death were upper gastrointestinalbleeding, liver failure, liver cancer etc. The48-month survival rate is70%.CONCLUSIONSBoth the on-demand endoscopic treatment and regluar endoscopic treatment inportal hypertensive gastroesophageal varices bleeding patients can effectively reduce theincidence of rebleeding and decrease6-month,12-month,24-month rebleeding rates. Combined with the patient’s own compliance on follow-up, the on-demandtreatment and the regular endoscopic treatment showed similar rebleeding rates.Compared with the regular treatment, the on-demand treatment showed noimprovement in mortality.Endoscopic adhesive-sclerosant mixature therapy of gastric varices is effective inimproving the frequency of rebleeding as a secondary prophylaxis method. |
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