Efficacy Of Endoscopic Treatment And Risk Factors Of Patients With Esophageal And Gastric Variceal Bleeding

Objective:This study aims to evaluate the effect of endoscopic ligation and / or tissue adhesive in the treatment of esophagogastric variceal bleeding in our hospital from January 2017 to January 2020,and to analyze the related risk factors of rebleeding in the median follow-up time after endoscopic treatment,so as to provide scientific reference for secondary prevention of rebleeding of esophagogastric variceal rupture.Method:We include patients with esophagogastric variceal bleeding who were treated with ligation and / or tissue adhesive.The success rate of emergency hemostasis,early rebleeding rate,delayed rebleeding rate,variceal elimination rate,marked efficiency,effective rate,ineffective rate,portal vein thrombosis,bleeding of drainage ulcer and so on were evaluated.After endoscopic treatment,52 patients with rebleeding and 135 patients without rebleeding were followed up in the median follow-up time.The general clinical data,WBC,HGB,PLT,ALB,TBIL,ALT,AST,Na,K,Cr,Pt,APTT,INR,FIB,D-dimer,Child-pugh classification,endoscopic classification and degree of esophagogastric varices,and CT portal vein imaging were collected.Spss25.0 software was used to analyze the data,establish regression prediction model,and use the receiver operating characteristic curve objective to analyze the predictive value of clinical data,and to explore the risk factors of rebleeding in the median follow-up time after ligation and / or tissue adhesive in the treatment of esophagogastric variceal bleeding,so as to provide scientific reference for clinical prevention of rebleeding of esophagogastric variceal rupture.Results:1.The median follow-up time of all 319 patients was 12.7months.From January 2017 to January 2020,319 patients underwent 573 times of endoscopic treatment,including 114 times of simple ligation,102 times of single glue tissue adhesive,and 357 times of ligation combined with tissue adhesive.2.Emergency endoscopic hemostasis 62 times,the success rate of hemostasis was 100.00%and the early rebleeding rate was 15.20%.3.During the follow-up period,the elimination rate of esophagogastric varices was 12.30%,the effective rate was 20.32%,the effective rate was62.03%,and the ineffective rate was 5.35%.The sum of the elimination rate of esophagogastric varices and the remission rate was 94.65%.The average times of treatment was 2.09 ± 0.18,and the average times of treatment was 3.76 ± 0.23.4.During the follow-up period,the median incidence of portal vein thrombosis was 4.81%.5.The incidence of bleeding from peptic ulcer during the median follow-up period after tissue adhesive therapy was 7.25%.6.The median follow-up rebleeding rate was 27.81%.7.After ligation and / or tissue adhesive treatment,the median follow-up time was full,and the univariate statistical results of rebleeding group and non rebleeding group were statistically significant AST,Cr,TBIL,ALB,PT,Child-pugh grade had statistical difference(P < 0.05),which was the risk factor of rebleeding after endoscopic treatment in patients with esophageal and gastric variceal bleeding.Multivariate logistic regression analysis was used to analyze the significant indicators of univariate analysis.The results showed that ALB,PT,AST were the risk factors of rebleeding after endoscopic treatment in patients with esophageal and gastric variceal bleeding.The area under the curve(AUC)of ALB was0.746,which was an independent risk factor(P < 0.05).Conclusion:1.Ligation and / or tissue adhesive injection is an effective treatment for esophagogastric variceal bleeding,which can effectively control the bleeding.The success rate of emergency hemostasis is high,and the rate of early and delayed rebleeding is low.However,the occurrence of peptic ulcer bleeding after the treatment of portal vein thrombosis and tissue adhesive should be paid attention to in clinical work.2.ALB、PT and AST are independent risk factors for rebleeding after endoscopic treatment in patients with esophageal and gastric variceal bleeding.ALB has a certain diagnostic efficiency for rebleeding in the median follow-up time after ligation and / or tissue adhesive injection in the treatment of esophageal and gastric variceal bleeding,and the AUC is 0.746.