Application Of Intensive Endoscopic Ligation And Tissue Glue Embolization In The Secondary Prevention Of Gastric Varices

ObjectiveTo compare the effects of endoscopic variceal ligation and endoscopic variceal embolization in the prevention of recurrent gastric variceal bleeding in patients with liver cirrhosis,and to explore the best secondary prevention scheme.MethodsA retrospective cohort study was conducted in 88 patients with esophageal and gastric varices who were admitted to People’s Hospital of Zhengzhou University from January 2018 to January 2020.They were divided into endoscopic variceal ligation(EVL)group and endoscopic variceal obturation(EVO)group.The clinical data including age,gender,serum albumin,serum bilirubin,prothrombin time,degree of ascites,etiology of liver cirrhosis was collected.Endoscopy data including the degree of esophageal varices,the degree and type of gastric varices was also collected.The treatment effects,postoperative adverse reactions,the sessions of treatments required to achieve the basic eradication of varices and the rebleeding status within 1 year were compared between the two groups.Results1.After the first treatment,9 patients in the EVL group were markedly effective,28 patients were effective,and 3 patients were ineffective.In the EVO group,11 patients were markedly effective,31 patients were effective,and 6 patients were ineffective.There was no significant difference in the improvement of gastric varices between the two groups(P=0.738).2.In the EVL group,nausea and vomiting occurred in 5 patients,fever in 4patients,sternal discomfort or pain in 8 patients and epigastric discomfort or pain in 7patients.The incidence of total adverse reactions was 60.0%.In the EVO group,nausea and vomiting occurred in 7 patients,fever in 3 patients,sternal discomfort or pain in 9patients and epigastric discomfort or pain in 7 patients.The incidence of total adverse reactions was 54.1%.There was no significant difference in the occurrence of adverse reactions between the two groups(P=0.582).3.In EVL group,9 patients achieved GV eradication after one session,15 patients received two sessions,and 16 patients needed at least three sessions.In EVO group,11patients’ varices were basically eradicated after one sessions,16 patients were treated twice,and 21 patients needed at least three sessions.There was no significant difference in the number of sessions needed to achieve basic eradication of GV between the two groups(P=0.912).4.The cumulative bleeding rates in the EVL group in 1 month,3 months,6 months and 12 months were 0,0,3.1%,and 19.1% respectively,while those in the EVO group were 6.3%,15.7%,23.7%,and 42.5% respectively.The Log-rank test showed that there was a significant difference in the incidence of rebleeding between the two groups(P=0.017).5.After adjusting for confounding factors in the Cox regression model,the risk of rebleeding in the EVO group was 4.23 times than the EVL group(HR=4.23,95%CI=1.52～11.76).ConclusionsBoth endoscopic variceal ligation and variceal obturation are safe and effective in the secondary prevention of gastric varices in patients with liver cirrhosis.There is no significant difference in the efficacy,adverse reactions,and the number of sessions required to eradicate varices between the two groups,but the effect of endoscopic variceal ligation in preventing rebleeding is better than variceal obturation.