| Backgound Esophagogastric varices（GOV）is a common complication of liver cirrhosis and the main cause of death in patients with liver cirrhosis.About 50%of patients with liver cirrhosis develop esophageal and gastric varices.Their existence is related to the severity of liver disease.Variceal bleeding occurs at an annual rate of 5-15%,and the mortality rate after 6 weeks of variceal bleeding is about 20%.Foreign guidelines recommend endoscopic variceal ligation or tissue glue as a treatment for preventing rebleeding of gastric varices.Studies have also shown that cyanoacrylate appears to be effective and safe in the treatment of gastric variceal bleeding or igh-risk scar bleeding under endoscope.However,there is a lack of evidence for the best endoscopic treatment of gastric variceal bleeding with different diameters.With the development of endoscopic treatment technology,solitary gastric varices can chieve a radical cure,but endoscopic treatment of esophageal varices（EV）or sophagogastric varices（EGV）is far from ideal.EVL eliminates varicose veins by mechanical ligation of rubber bands.After repeated EVL treatment,about 90%of EVB patients achieved functional eradication of varicose veins.For EV patients who are bleeding,EVL can achieve immediate hemostatic effect,but the recurrence of varicose veins is not uncommon.Only by blocking the reflux of esophageal varices can the desired effect be achieved.Combined with the previous study of esophageal variceal pressure measurement by balloon,our group imagines that an inflatable alloon（hereinafter referred to as balloon）is placed in the esophageal lumen.When the diameter of the balloon exceeds the internal diameter of the esophagus,the aricose vein collapses under pressure and the blood flow is interrupted.The clerosing agent can be retained in the local varicose vein.Our group designed a new type of swimming ring-shaped balloon,which was placed on the top of the endoscope and inflated with a diameter of 3.5cm.The preliminary test achieved the goal of locking blood flow.Objective To evaluate the risks and benefits of endoscopic ligation and tissue adhesives in the treatment of tortuous gastric varices;To explore the efficacy and safety of balloon compression-assised endoscopic injection sclerotherapy（bc-EIS）in treatment for esophageal varices.Methods（1）A total of 533 patients withesophagogastric varices,who underwent ndoscopic variceal ligation or endoscopic tissue adhesive injectionin the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from June 2015 to June 2020,were included in the retrospective analysis.These cases were connected vessels（type Le and GF based on LDRf standard）of tortuous astric varices（F1 in Hashizume standard）,nodular（F2 in Hashizume standard）and tumorous（F3 in Hashizume standard）.In each type,they were divided into 3 roups according to the endoscopic treatment method,namely F1 type（193 cases）:gastric fundus and esophageal ligation group（32 cases）,tissue adhesive group（71cases）and esophageal ligation group（90 cases）.F2 type（223 cases）:gastric fundus and esophageal ligation group（35 cases）,tissue adhesive group（110 cases）and sophageal ligation group（78 cases）.F3 type（117 cases）:gastric fundus and esophageal ligation group（30 cases）and tissue adhesive group（87 cases）.The rebleeding rate,the significant effectiveness rate and complications of the three ndoscopic treatment methods in each type were compared and analyzed.In F1 type,the rebleeding rate,the effectiveness rate,the significant effectiveness rate and omplications of the three endoscopic treatment methods were analyzed.（2）Prospective selection of 38 patients with liver cirrhosis and esophageal varices who underwent bc-EIS at the First Affiliated Hospital of Anhui Medical University from June 12 to September 12,2020,and calculate the amount of sclerosing agent used,the number of sclerosing agent injection points,whether the intraoperative injection point is bleeding（no bleeding,oozing,spurting）,whether compression is needed to stop leeding（no need,needle sheath compression to stop bleeding,transparent cap compression to stop bleeding）,early（operation After 72 h to 6 weeks）rebleeding,delayed（6 weeks postoperative）bleeding,and the number of treatments for the complete disappearance of esophageal varices.The postoperative follow-up period was 1,3,and 6 months to evaluate the efficacy of bc-EIS and postoperative omplications.Results（1）F1:（1）The rates of rebleeding in gastric fundus and esophageal ligation group,tissue adhesive group and esophageal ligation group were 18 75%（6/32）,1268%（9/71）and 3 33%（3/90）,respectively There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group（χ~2=6 110,P<0 016）.（2）The effectiveness rates of the three groups wereall 10000%.The significant effectiveness rates in gastric fundus and esophageal ligation roup,tissue adhesive group and esophageal ligation group were 37 50%（12/32）,25 35%（18/71）and 14 44%（13/90）,respectively.There was significant difference only between gastric fundus and esophageal ligation group and esophageal igation group（χ~2=7 702,P<0 016）.（3）No pulmonary infection,hepatic encephalopathy,spontaneous bacterial peritonitis or perforation occurred in the three groups The incidences of chest pain or abdominal pain in gastric fundus and esophageal ligation group,tissue adhesive group and esophageal ligation group were18 75%（6/32）,11 27%（8/71）and 2 22%（2/90）,respectively There was ignificant difference only between gastric fundus and esophageal ligation group and esophageal ligation group（χ~2=10 524,P<0 016）There was no significant ifference in the incidence of fever,nausea or vomiting among the three groups（P>0 05）.（2）Prospective selection of 38 patients with liver cirrhosis and esophageal varices who underwent bc-EIS at the First Affiliated Hospital of Anhui Medical University from June 12 to September 12,2020,and calculate the amount of sclerosing agent used,the number of sclerosing agent injection points,whether the intraoperative injection point is bleeding（no bleeding,oozing,spurting）,whether compression is needed to stop leeding（no need,needle sheath compression to stop bleeding,transparent cap compression to stop bleeding）,early（operation After 72 h to 6 weeks）rebleeding,delayed（6 weeks postoperative）bleeding,and the number of treatments for the complete disappearance of esophageal varices.The postoperative follow-up period was 1,3,and 6 months to evaluate the efficacy of bc-EIS and postoperative omplications.Conclusion（1）F1:Simultaneous endoscopic ligation of gastric fundus and esophageal varices,and endoscopic tissue adhesive injection of gastric varices ombined with endoscopic ligation of esophageal varices is of no benefit for patients with tortuous gastric varices,but endoscopic ligation of sophageal varices alone may yield more benefit.（2）The dosage of sclerosing medication in bc EIS is reduced by half compared with the recommended amount in the guidelines,and the injection point bleeding is less,especially the rate of complete disappear ofesophageal varices is more than 70%after the first treatment. |
PDF Full Text Request