Comparison Of Curative Effect Of Esophageal Variceal Ligation In Patients With Or Without Portal Vein Thrombosis

BackgroundEsophageal variceal bleeding(EVB)is one of the serious complications of liver cirrhosis with high incidence,large amount of bleeding and high mortality.The mortality rate of variceal bleeding for the first time is very high,which can reach about 1x3.About 50%of patients without standard treatment and prevention have the risk of rebleeding,and the fatality rate of rebleeding is as high as 70%.Therefore,it is very important to prevent esophageal variceal bleeding for the first time or rebleeding.Endoscopic variceal ligation(EVL)has become the first choice for the treatment of esophageal varices(EV)due to its small trauma and good curative effect.Portal vein thrombosis(PVT)refers to the thrombosis of the main portal vein,its left and right branches,splenic vein and mesenteric vein.It is a kind of deep vascular obstructive disease.Patients with liver cirrhosis are prone to PVT because of the slowing down of portal blood flow,hypercoagulable state and vascular endothelial injury.The incidence of PVT in patients with liver cirrhosis is 5%-20%,which is one of the common complications of liver cirrhosis.In the past,whether the formation of PVT affects the prognosis of patients with liver cirrhosis remains controversial.Some scholars believe that PVT and cirrhosis are only two manifestations of end-stage liver disease,there is no causal relationship.However,most studies believe that PVT has a negative impact on the prognosis of patients with liver cirrhosis,because PVT can reduce liver blood perfusion and liver parenchyma atrophy,leading to deterioration of liver function.The formation of PVT leads to portal vein stenosis,which can further increase the portal vein pressure in patients with liver cirrhosis,thus increasing the incidence of esophageal varices.However,there are few studies at home and abroad on whether the formation of PVT has an impact on the efficacy of EVL.This study retrospectively analyzed the clinical data of cirrhotic patients with esophageal varices who received EVL,and compared the efficacy of EVL between patients with PVT and patients without PVT.ObjectiveObjective to analyze the difference of curative effect of endoscopic variceal ligation(EVL)between patients with and without portal vein thrombosis(PVT)in liver cirrhosis with esophageal varices(EV),so as to provide the basis for the treatment of liver cirrhosis with PVT.MethodsThe clinical data of 181 patients with cirrhotic esophageal varices treated by endoscopic EVL in the first affiliated Hospital of Zhengzhou University from June 2013 to December 2019 were collected retrospectively.The patients were divided into PVT group(35 cases)and non PVT group(146 cases).The number of courses and elimination rate of EV elimination,the recurrence time and recurrence rate of EV,and the recurrence rate of EV were compared between the two groups The bleeding situation and the success rate of emergency endoscopic hemostasis between the two groups were statistically different,and the effect of different types of PVT on the efficacy of EVL was analyzed.Results1.There was no significant difference in age,sex ratio,etiology of liver cirrhosis,platelet,creatinine level and child Pugh grade between PVT group and non PVT group(P>0.05).2.In the PVT group,25 cases of esophageal varices were eliminated after treatment,and 6 cases of esophageal varices decreased after treatment.The elimination rate of esophageal varices was 71.4%(25/35),the remission rate of esophageal varices was 17.1%(6/35),and the total effective rate was 88.6%(31/35).In the non PVT group,109 cases of esophageal varices were eliminated after treatment,24 cases of esophageal varices decreased after treatment,the elimination rate of esophageal varices was 74.7%(109/146),the remission rate of esophageal varices was 16.4%(24/146),and the total effective rate was 91.1%(133/146).There was no significant difference in the elimination rate and total effective rate between the two groups(P>0.05).3.The median number of EVL courses in PVT group was 3.0(2.3,4.0)times,which was more than 2.0(2.0,3.0)times in non PVT group(P<0.05).4.The recurrence rate of esophageal varices in PVT group was 48.0%(12/25),which was not significantly different from that in non PVT group(43.1%(47/109)(P>0.05);the median recurrence time of esophageal varices in PVT group was 12.0 months,which was not significantly different from that in non PVT group(17.4 months)(P>0.05).5.In the PVT group,13 patients had rebleeding during the treatment and follow-up period,including 2 patients with early rebleeding and 11 patients with delayed rebleeding.In the non PVT group,30 patients had rebleeding during the treatment and follow-up period,including 4 patients with early rebleeding and 26 patients with delayed rebleeding.The rebleeding rate of PVT group was 37.1%(13/35)higher than that of non PVT group(20.5%(30/146),the difference was statistically significant(P<0.05).6.In the PVT group,6 cases had acute esophageal variceal bleeding,and the emergency endoscopic ligation treatment was successful;in the non PVT group,19 cases had acute esophageal variceal bleeding,and the emergency endoscopic ligation treatment was successful.The success rate of emergency endoscopy was 100%in both groups,and the difference was not statistically significant(P>0.05).7.There was no significant difference in the elimination rate,recurrence rate and rebleeding rate of patients with different types of PVT after EVL treatment(P>0.05).ConclusionIn patients with liver cirrhosis complicated with PVT,it takes longer course of treatment to eliminate esophageal varices by EVL,and the rebleeding rate is high during the follow-up.However,PVT does not affect the recurrence rate and recurrence time of esophageal varices after the elimination of esophageal varices.