Retrospective Analysis On Clinical Curative Effects Of Endoscopic Tissue Adhesive Injection And Ligation For Type 1 Gastroesophageal Varices

BackgroundEsophagogastric variceal bleeding is one of the main causes of acute upper gastrointestinal bleeding and one of the most common and serious complications of decompensated cirrhosis.Gastric variceal accounts for about 10%?20%of patients with portal hypertension,15?30%of them will have bleeding,mortality rate is as high as 16%,blood transfusion requirement and mortality rate were higher than esophageal varices.The gastric varices are usually classified to type 1 GOVs?type 2 GOVs?type 1 isolated GVs?type 2 isolated GVs according to Sarin classification.Type 1 GO Vs is a special type of gastric varices which extends for 2?5 cm below the gastroesophageal junction.GOV1 were distributed on the lesser curvature of the stomach,accounting for about 74.6%of gastric varices.At present,there are some controversies about the optimal treatment of gastric varices especially GOV1.Some experts recommend endoscopic tissue adhesive injection for gastric variceal,which can quickly control the bleeding and prevent rebleeding.But endoscopic tissue adhesive injection has a number of complications such as infection,systemic thromboembolic,ulcer,rebleeding and glue extruded.Recently some studies have reported that comparing to endoscopic tissue adhesive injection,endoscopic variceal ligation is no less effective in the treatment of gastric varices,especially GOV1.It doesn't have complications such as abnormal embolism and can reduce the burden of patients.At present,there are few related studies at home and abroad,and most of them are curative effect observation,lack of cost-effective analysis.This study retrospectively analyzed the efficacy,complications and cost-effective of EVL and endoscopic tissue adhesive injection for GOV1.ObjectiveTo compare clinical curative effects and cost-effective of endoscopic tissue adhesive injection and ligation for type 1 gastroesophageal-varices and provide reference for clinical treatment.MethodA total of 72 patients with type 1 gastroesophageal varices who underwent endoscopic tissue adhesive injection and ligation treatment from June 2017 to June 2019 in the First Affiliated Hospital of Zhengzhou University were collected in this study.The patients were divided into group A(tissue adhesive injection,42 patients)and group B(endoscopic ligation,30 patients)according to therapeutic methods.The relevant data of the 72 patients were collected and compared.Patients general data such as age,sex,underlying liver disease,were collected.Results of laboratory tests include platelet count,international normalized ratio(INR),alanine aminotransferase(ALT),bilirubin,creatinine,MELD score,Child-Pugh score.The clinical data include operation,complications,hospital expenses and so on.The efficacy,complications,hospital expenses were compared between the two groups.Result1.One of 36 patients had active bleeding within 72 hours after endoscopic tissue adhesive injection,the success rate of hemostasis was 97.2%(35/36).Two of the 22 patients with acute bleeding had active bleeding within 72 hours after endoscopic variceal ligation,the success rate of hemostasis was 90.9%(20/22)?There was no statistically significant difference in surgical success rate between the two groups(P>0.05).2.One case of early rebleeding and two cases of delayed bleeding occurred in 42 patients treated with endoscopic tissue adhesive injection,and the rebleeding rate was 7.1%(3/42).One case of early rebleeding and three cases of delayed bleeding occurred in 30 patients treated with endoscopic variceal ligation,and the rebleeding rate was 13.3%(4/30).There was no statistically significant difference in overall bleeding rates between the two groups(P>0.05).3.Of the 42 patients in the endoscopic tissue adhesive injection group,16 were evaluated as significant effective,21 as effective,and the overall efficiency rate was 88.1%(37/42).Of the 30 patients in the endoscopic variceal ligation group,8 were evaluated as significant effective,20 as effective,and the overall efficiency rate was 93.3%(28/30).There was no statistically significant difference in overall bleeding rates between the two groups(P>0.05).4.There were 6 patients with retrosternal pain,2 patients with fever and 1 case of pulmonary infection after endoscopic tissue adhesive injection,and the overall incidence of complications was 21.4%(9/42).There were 2 patients of retrosternal pain,1 patients of pulmonary infection,1 case of hepatic encephalopathy and 1 case of gastric ulcer after endoscopic variceal ligation group.the overall incidence of complications was 16.7%(5/30).There was no statistically significant difference in overall incidence of complications between the two groups(P>0.05).5.The cost of each 1%increase in overall efficiency rate in endoscopic tissue adhesive injection group was(329.85±194.02 yuan),much higher than that in endoscopic variceal ligation group(213.29±141.02 yuan).There was statistically significant difference in cost-effectiveness analysis between the two groups(P<0.05).ConclusionCompared to endoscopic tissue adhesive injection,endoscopic type 1 gastroesophageal varices ligation can significantly reduce the medical burden of patients without reducing the total effective rate and increasing total rate of adverse reactions.