The Role Of Over-tube In Emergency Endoscopic Treatment Of Esophageal And Gastric Variceal Bleeding

Background and Purpose:As one of the serious complications of portal hypertension,the incidence of esophageal and gastric variceal veins accounts for about 50% of patients with portal hypertension,and the incidence of rupture bleeding is about 25%,at the same time,the incidence of death caused by initial bleeding is about 20-35%;Meanwhile,the probability of re-bleeding within 1 year is about 60%.And in the process of emergency varices treatment,the bleeding from a ruptured vein leads to unclear vision,meanwhile,the applications such as nausea,vomit make the possibility of useful treatment not optimistic,and it can increase the risk of aspiration.What's more,postoperative complications such as fever,ulcers,chest pain make us confused.So Baveno VI declares that endotracheal intubation when administer endoscopic treatment is recommended in acute esophagogastric variceal bleeding(AEGVB),but the technology is difficult to carried out in grass-roots hospitals comprehensive.In recent years,some research had pointed out that in the process of endoscopic treatment with over-tube technology,it can not only effectively protect the airway,reducing the aspiration incidents and various postoperative complications,but also does not increase postoperative re-bleeding rate and mortality.Our research had divided the patients with AEGVB into two groups,one named group of endotracheal intubation,and the other is group of over-tube,and using retrospective analysis to collect patients' preoperative clinical data,the incidence of postoperative pneumonia,length of hospital stay,hospital expenses and incidence of re-bleeding and long-term survival.We use this method to explore the safety and effectiveness of over-tube in esophageal gastric varices bleeding.Materials and Methods:Choosing 118 EGVB patients between January 2014 and December 2018 in jilin university first hospital for acute endoscopic treatment as research objects,and the inclusion criteria are: diagnosis accord with <Guidelines for the prevention and treatment of cirrhotic portal hypertension and esophageal and gastric variceal hemorrhage> in 2016,exclusion criteria are: there are upper gastrointestinal endoscopy taboo,uncontrolled hemorrhagic shock,patients with severe liver and kidney failure.Grouping: patients using over-tube named as the over-tube adjuvant treatment group and the patients using endotracheal intubation acted as endotracheal intubation adjuvant treatment group.Preoperative relevant clinical data of the subjects were collected,including basic data of the patients,liver function level;Intra-operative endoscopic blood reflux and variceal veins grading;Postoperative pneumonia,length of hospital stay,hospital expenses,the rate of postoperative re-bleeding and survival rate were analyzed statistically.Results:1.The average preoperative albumin of patients in the endotracheal intubation group was lower than that in the over-tube group,with statistically significant difference between the two groups(P<0.05).The number of Child-Pugh grade C patients in the endotracheal intubation group was higher than that in the over-tube group,and the difference was statistically significant(P<0.05).2.There was no significant difference in intra-operative endoscopic blood reflux and variceal vein grading between the two groups(P>0.05).3.The incidence of postoperative pneumonia in the endotracheal intubation group was higher than that in the over-tube group,and the difference was statistically significant(P<0.05),but there was no significant difference in the incidence of aspiration pneumonia between the two groups(P>0.05).4.There was no statistically significant difference in length of hospital stay between the two groups(P>0.05),but the difference in hospital expenses between the two groups was statistically significant(P<0.01).5.During the postoperative follow-up period,there were no statistically significant differences between the two groups in the rate of early and late re-bleeding and long-term survival(P>0.05).Conclusions:1.The incidence of aspiration pneumonia using over-tube to assist endoscopic treatment of esophagogastric variceal hemorrhage is similar to that in endotracheal intubation,indicating that over-tube can effectively protect the airway;2.Over-tube assisted emergency endoscopic treatment can reduce the hospitalization expenses and economic burden of patients;3.The application of over-tube assisted emergency endoscopic therapy does not increase the rate and mortality of postoperative re-bleeding,indicating that over-tube assisted emergency endoscopic therapy for esophageal and gastric variceal hemorrhage is safe and effective.4.Endotracheal intubation is recommended as an effective airway protection measure for emergency endoscopic variceal bleeding treatment,and the occurrence of postoperative pneumonia may be related to albumin level and Child-Pugh grading,and its independent risk factors need to be further explored.