中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 1
Jan.  2021
Turn off MathJax
Article Contents

Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus

DOI: 10.3969/j.issn.1001-5256.2021.01.014
  • Received Date: 2020-07-27
  • Accepted Date: 2020-09-07
  • Published Date: 2021-01-20
  •   Objective  To investigate the risk factors for failure in emergency endoscopic injection sclerotherapy (EIS) combined with sequential histoacryl injection (HI) for esophagogastric variceal bleeding (EGVB) with portal vein embolus (PVE).  Methods  A total of 109 EGVB patients with PVE who underwent emergency gastroscopy in Beijing Shijitan Hospital, Capital Medical University, and The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to December 2019 were enrolled, and according to the outcome of hemostatic treatment under emergency gastroscopy, the patients were divided into hemostatic failure group with 28 patients and hemostatic success group with 81 patients. The two groups were compared in terms of general information, varices and bleeding manifestations under gastroscopy, blood biochemical parameters, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the risk factors for hemostatic failure were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a logistic regression analysis was used for multivariate analysis.  Results  Compared with the hemostatic success group, the hemostatic failure group had significantly higher peripheral white blood cell count (WBC), total bilirubin (TBil), Child-Pugh class, and MELD score (Z=3.794, Z=4.751, χ2=40.104, Z=6.412, all P < 0.001) and significantly lower prothrombin time activity (PTA), albumin (Alb), and cholinesterase (CHE) (t=9.653, Z=3.093, Z=4.092, P < 0.001, P=0.002, and P < 0.001). WBC (odds ratio [OR]=28.543, 95% confidence interval [CI]: 1.285-634.113, P < 0.05), PTA(OR=0.194, 95%CI: 0.045-0.835, P < 0.05), TBil (OR=2.197, 95%CI: 1.004-4.810, P < 0.05), Alb (OR=0.448, 95%CI: 0.209-0.961, P < 0.05), and Child-Pugh class (OR=5.164, 95%CI: 1.307-20.406, P < 0.05) were independent risk factors for hemostatic failure.  Conclusion  WBC, PTA, TBil, Alb, and Child-Pugh class are independent risk factors for failure in emergency EIS combined with sequential HI in the treatment of EGVB with PVE, and adequate preoperative evaluation and correction may help to improve the success rate of hemostasis.

     

  • loading
  • [1]
    RUAN FM, LI BM. Risk factors for the formation of portal vein thrombosis in patients with liver cirrhosis[J]. J Clin Hepatol, 2020, 36(1): 182-185. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.01.043

    阮芳鸣, 李弼民. 肝硬化门静脉血栓形成的危险因素[J]. 临床肝胆病杂志, 2020, 36(1): 182-185. DOI: 10.3969/j.issn.1001-5256.2020.01.043
    [2]
    PELLICELLI A, AMBROSIO D, BABARO G, et al. Clinical and genetic factors associated to development of portal vein thrombosis in cirrhotic patients without hepatocellular carcinoma[J]. J Hepatol, 2011, 54: s77.
    [3]
    AL-KHAZRAJI A, CURRY MP. The current knowledge about the therapeutic use of endoscopic sclerotherapy and endoscopic tissue adhesives in variceal bleeding[J]. Expert Rev Gastroenterol Hepatol, 2019, 13(9): 893-897. DOI: 10.1080/17474124.2019.1652092
    [4]
    TRIPATHI D, STANLEY AJ, HAYES PC, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut, 2015, 64(11): 1680-1704. DOI: 10.1136/gutjnl-2015-309262
    [5]
    ZHANG WH, LI L, HAN J, et al. Endoscopic diagnosis and therapy for 134 cirrhotic patients with cardiac variceal bleeding[J]. Infect Dis Info, 2014, 27(2): 97-99. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-CRBX201402010.htm

    张文辉, 李莉, 韩军, 等. 肝硬化合并贲门区曲张静脉破裂出血134例内镜诊疗分析[J]. 传染病信息, 2014, 27(2): 97-99. https://www.cnki.com.cn/Article/CJFDTOTAL-CRBX201402010.htm
    [6]
    KIM DH, CHO E, JUN CH, et al. Risk factors and on-site rescue treatments for endoscopic variceal ligation failure[J]. Korean J Gastroenterol, 2018, 72(4): 188-196. DOI: 10.4166/kjg.2018.72.4.188
    [7]
    Chinese Medical Association of Liver Diseases, Chinese Medical Association of Gastroenterology, Chinese Medical Association of Endoscopy. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhosis portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2016.02.002

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002
    [8]
    BARRERA F, ZÚÑIGA P, ARRESE M. Prediction of esophageal variceal bleeding in liver cirrhosis: Is there a role for hemostatic factors?[J]. Semin Thromb Hemost, 2015, 41(5): 481-487. DOI: 10.1055/s-0035-1550438
    [9]
    TRIPATHI D, STANLEY AJ, HAYES PC, et al. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension[J]. Gut, 2020, 69(7): 1173-1192. DOI: 10.1136/gutjnl-2019-320221
    [10]
    JIANG CW, WANG AJ, ZHANG JL, et al. Endoscopic therapy for liver cirrhosis with esophageal variceal bleeding[J]. J Clin Hepatol, 2019, 35(6): 1365-1368. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.06.041

    江长文, 汪安江, 张金莲, 等. 肝硬化食管静脉曲张破裂出血的内镜治疗[J]. 临床肝胆病杂志, 2019, 35(6): 1365-1368. DOI: 10.3969/j.issn.1001-5256.2019.06.041
    [11]
    MA L, TSENG Y, LUO T, et al. Risk stratification for secondary prophylaxis of gastric varices due to portal hypertension[J]. Dig Liver Dis, 2019, 51(12): 1678-1684. DOI: 10.1016/j.dld.2019.05.020
    [12]
    KONDO T, MARUYAMA H, KIYONO S, et al. Similarities and differences in the clinical features between cardia varices and esophageal varices[J]. J Gastroenterol Hepatol, 2014, 29(11): 1911-1918. DOI: 10.1111/jgh.12647
    [13]
    HU Z, ZHANG D, SWAI J, et al. Risk of rebleeding from gastroesophageal varices after initial treatment with cyanoacrylate; a systematic review and pooled analysis[J]. BMC Gastroenterol, 2020, 20(1): 181. DOI: 10.1186/s12876-020-01333-9
    [14]
    VINCENT JK, STARK C, SHIELDS JT, et al. Hepatic venous pressure gradient correlates with advanced hepatic fibrosis: A retrospective review[J]. Abdom Radiol(NY), 2017, 42(11): 2609-2614. DOI: 10.1007/s00261-017-1171-y
    [15]
    XUE YJ, YANG L, ZHU Y, et al. Value of the serum albumin, cholinesterase and prothrombin activity in the diagnosis of viral hepatitis cirrhosis[J]. Acta Acad Med Bengbu, 2019, 44(3): 306-308, 313. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-BANG201903008.htm

    薛永举, 杨丽, 朱玉, 等. 血清白蛋白、胆碱酯酶及凝血酶原活动度对病毒性肝炎肝硬化的诊断价值[J]. 蚌埠医学院学报, 2019, 44(3): 306-308, 313. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG201903008.htm
    [16]
    FAN ZL, XIN KF. Study on the predictive value of coagulation index and platelet parameters in patients with liver cirrhosis and portal hypertension[J]. Clin J Med Offic, 2019, 47(9): 936-937. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ201909017.htm

    范子玲, 辛克锋. 凝血指标与血小板参数在肝硬化门静脉高压患者消化道出血中预测价值研究[J]. 临床军医杂志, 2019, 47(9): 936-937. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ201909017.htm
    [17]
    DARWEESH SK, ELSABAAWY MA, ELTAHAWY MA, et al. Serum ammonia as a non-invasive marker for early prediction of esophageal varices[J]. Eur J Gastroenterol Hepatol, 2020.[Online ahead of print] http://journals.lww.com/eurojgh/Abstract/9000/Serum_ammonia_as_a_non_invasive_marker_for_early.97602.aspx
    [18]
    CHEN SH, WAN QS, WANG T, et al. Fluid biomarkers for predicting the prognosis of liver cirrhosis[J]. Biomed Res Int, 2020, 2020: 7170457.
    [19]
    ASRANI SK, KAMATH PS. Prediction of early mortality after variceal bleeding: Score one more for MELD[J]. Gastroenterology, 2014, 146(2): 337-339. DOI: 10.1053/j.gastro.2013.12.022
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(4)

    Article Metrics

    Article views (730) PDF downloads(47) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return