Muiticenter Clinical Study Of Endoscopic Treatment In Gastro-esophageal Varices Bleeding

Objective: To investigate the clinical efficacy of endoscopic variceal ligation(EVL)in the treatment of type 1 gastroesophageal varices(GOV1).And to compare the efficacy between endoscopic clipping prior to N-butyl-2-cyanoacrylate injection(GVO)and only GVO for the treatment of isolated gastric varices type I(IGV1).To provide clinical reference and basis for the choice of the treatment scheme for variceal hemorrhage.Methods:(1)From July 2016 to May 2017,at our hospital,NO.2 People's Hospital of Fuyang City and the Sixth People's Hospital of Shenyang,the efficacy of EVL in the treatment of patients with GOV1 were retrospectively analyzed.The number of ligation rings,emergency(bleeding with in 24 hours)hemostasis,successful hemostasis,early rebleeding(from 72 hours to six weeks after operation),delayed rebleeding(at six weeks after operation)and disappearance of gastroesophageal varices were observed.Patients were followed up for six to 16 months and postoperative complications of EVL were evaluated.(2)Data was collected retrospectively at three medical centers.A total of 96 patients were enrolled between March 2015 and April 2017 and divided into two groups: group I(patients with endoscopic clipping prior to GVO,n=46)and group II(patients with only GVO,n=50).Computed tomography angiography(CTA)was performed to evaluate the status of gastrorenal shunts(GRS)and splenorenal shunts(SRS).Results:(1)There were 61 patients with GOV1(40 male and 21 female),and the mean age was(50.9±10.9)years.The number of ligation during EVL operation was one to six(mean3.8±1.9).Seven patients with active bleeding were all successfully achieved emergency hemostasis.One case had rebleeding in 72 hours after operation,and the hemostatic rate was 98.3%(60/61).The early rebleeding rate was 11.5%(7/61),The delayed rebleeding rate was 4.9%(3/61),and the total rebleeding rate was 16.4(10/ 61).The disappearance rate of gastroesophageal varices was 85.2%(52/61).The complication rate was 21.3%(13/61).No post-ligation ulcer bleeding,spontaneous bacterial peritonitis and perforation were observed in all patients.(2)Initial hemostasis was successful in all the patients.The mean number of injection points per session and the volume of N-butyl-2-cyanoacrylate in group I were 4.17±0.30 points and 3.39±1.20 ml.The rebleeding rate in group I was4.35%(2/46).Variceal obliteration was achieved by one session in all patients and the complication rate was 39.13%(18/46)in group I.The mean number of injection points per session and the volume of N-butyl-2-cyanoacrylate in group II were 3.39±1.20 points and 2.53±1.05 ml.The rebleeding rate in group II was18.00%(9/50).Variceal obliteration rate was 72%(36/50)and the complication rate was 40.00%(20/50)in group II.The results showed that clipping before N-butyl-2-cyanoacrylate injection decreased the rebleeding rate and increased variceal obliteration significantly(P<0.05),also has better safety in preventing ectopic embolization.Conclusion:(1)EVL can effectively control the active hemorrhage GOV1 type gastric varices.The postoperative rebleeding rate and complication rate are low.Howere,the disappearance rate of varices is high.(2)Endoscopic clipping prior to GVO may be an appropriate alternative to GVO as a treatment modality for IGV1 bleeding.