| Objective:By analyzing the clinical data of the cirrhotic patients with moderated-severe esophageal gastric varices(EGV),to discover the potential influencing factors associated with the occurrence of the moderated-severe EGV as well as the EGV rebleeding after endoscopic therapy,and to evaluate the efficacy and prognosis of different precision endoscopic treatment strategies(single position or position combination)in treating the moderated-severe EGV of cirrhotic patients with history of varicose bleeding.Method:The clinical records of cirrhotic patients with moderated-severe EGV were retrospectively collected,who had underwent endoscopic examination or treatment in the endoscopic center of gastroenterology of the first affiliated hospital,School of medicine,Zhejiang university between December 2012 and May 2018,and 127 patients were enrolled into the study based on the exclusion criteria.In the first half of the study,additional 67 cirrhotic patients with mild EGV in the corresponding period were also enrolled as comparison group.The potential influencing factors on moderated-severe EGV occurrence were screened out by comparing the clinical records between the two groups.The predictive power of the factors were further assessed with receiver operating characteristic curve(ROC).In the second half of the study,a total of 68 patients was selected out of 127 patients according to the exclusion criteria for this part,who were divided into two precision endoscopic treatment groups:"single-position"treatment only for the esophageal or gastric varices(n=38)and "position-combination"treatment for the esophagogastric varices(n=30).All the patients were followed up until March 2019 or death or occurrence of rebleeding.The differences in the efficacy and prognosis of two endoscopic treatment strategies were evaluated,and the possible parameters relevant to varicose rebleeding after the endoscopic treatment were explored.The data were analyzed with SPSS 20.0 statistical software(SPSS,Inc.,Chicago,IL,USA).Results:The independently influencing factors associated with moderated-severe EGV in cirrhosis were the history of EGV bleeding as well as more times of bleeding occurrences,the number of the esophageal varices?3,the serum calcium(Ca)and hemoglobin(HB).Low level of Ca and HB were the high-risk factors for the development of moderated-severe EGV.The cirrhotic patients had significantly higher risk of developing moderated-severe EGV if they had Ca<2.11mmol/L and HB<110.5g/L.The endoscopic "position-combination" treatment group was advantageous over "single-position" treatment group in alleviation of moderated-severe EGV after first treatment and reduction of necessary endoscopic treatment sessions in the long run.Between the two treatment groups,the rebleeding rate,the patients'survival curve without rebleeding,death rate and rate of complications were statistically comparable.The history of splenectomy or spleen embolization and higher alanine aminotransferase to platelet count ratio(ALT/PLT)were possibly associated with rebleeding after endoscopic treatment for moderated-severe EGV in cirrhotic patients,however,these two were not the independently influencing factors.Conclusion:The cirrhotic patients with the history of EGV bleeding as well as more times of bleeding occurrence,the number of the esophageal varices?3,Ca<2.11mmol/L,HB<110.5g/L had higher rate of developing moderated-severe EGV.Regarding to the precision endoscopic treatment for moderated-severe EGV,the efficacy and prognosis of two treatment strategies(single-position treatment and position-combination treatment)were comparable.However,for the patients having underwent position-combination treatment,the rate of EGV alleviation after first treatment session was higher and fewer endoscopic treatment sessions were required in the long run.The history of splenectomy or spleen embolization and higher ALT/PLT were possible influencing factors on the rebleeding after endoscopic treatments for moderated-severe EGV in cirrhosis. |
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