The Outcome And Risk Factor Of Re-bleeding After Endoscopic Using Tissue Adhesive In Treating Gastric Varices

Objective:To retrospectively analyze the efficacy of endoscopic gastric varices obturation using tissue adhesive and follow up the rebleeding patients after endoscopic treatment.To analyze the risk factors of such patients.Methods:1.Collect 58 patients with liver cirrhosis from January 2013 to January2018 admitted to the Department of Gastroenterology of the Second Hospital of Hebei Medical University.These patients with severe gastric varices treated with endoscopic variceal obturation were observed.2.The therapeutic effects were evaluated by retrospective analysis of the disappearance rate,total effective rate,repeated treatment rate,recurrence rate,rebleeding rate,mortality and complications.3.According to the rebleeding of patients after endoscopic treatment,it was divided into bleeding group and non-bleeding group.Recording the patient's general information and using single factor?multi-factor logistic regression analysis,to obtain the independent risk factors.For the statistically significant indicators,the area under the curve(AUC)of the receiver operating characteristic curve(ROC)was calculated to judge the diagnostic value of each index.Results:1.A total of 58 patients with gastric varices were enrolled,including 36males(62.0%)and 22 females(37.9%),with an mean age of 53.6+13.3 years.2.In this study,the success rate of hemostasis was 100%after internal medicine and endoscopic treatment.Among the 58 patients with endoscopic gastric varices obturation using tissue adhesive,50(86.2%)cases were effective,including 28(48.2%)cases with gastric varices disappeared,21(36.3%)cases with significant effects,1(1.7%)case with mild effect,8(13.8%)cases with ineffective effects,10(17.2%)cases with repeated endoscopic treatment with tissue adhesives,and 1 cases(1.7%)with recurrent effects.There were 3 deaths,the mortality rate was 5.1%.3.In this study,16 patients had rebleeding during the follow-up,and the rate of rebleeding was 27.58%,7 patients(12%)with early rebleeding.There were statistical differences in PLT(P=0.041),ALB(P=0.012),Cr(P=0.041)and child-pugh grading(P=0.034)between the two groups.Univariate Logistic analysis showed that PLT,ALB and child-pugh grade A were negatively correlated with re-bleeding after endoscopic tissue adhesion therapy for gastric varices(P<0.05).Multivariate Logistic regression analysis showed that platelets were independent risk factors for re-bleeding.The area(AUC)under the platelet(PLT)curve was 85.3%,the optimal platelet value was 73.5×10~9/L,the sensitivity was 86%,and the specificity was 73.5%.4.Complications:postoperative fever(3 cases),nausea and vomiting(1case),chest and abdominal pain(2 cases),1 patient with dysphagia who combined esophageal varices,was treated by EVL and EIS therapy,no ectopic embolism.Conclusions:1.Endoscopic variceal obturation which has high success rate of hemostasis,can be used as the preferred treatment of acute gastric varices bleeding and has the characteristics of good short-term efficacy,low recurrence rate and mortality.2.The potential influencing factors of rebleeding after endoscopic treatment are platelet,albumin and Child-Pugh A grade,of which platelet is independent risk factors.