Xing Wang1,2, Jinni Luo1,2, Chuan Liu3, Yanna Liu4, Xiaoying Wu1,2, Fengping Zheng1,2, Zhuofu Wen1,2, Hong Tian1,2, Xiuqing Wei1,2, Yunwei Guo1,2, Jianzhong Li1,2, Xiaoliang Chen1,2, Jin Tao1,2, Xiaolong Qi4, Bin Wu1,2. 1. Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 2. Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China. 3. Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China. 4. CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China.
Abstract
BACKGROUND: Endoscopic therapy has been widely applied to prevent variceal rebleeding, but data addressing the effect of endoscopic variceal eradication (VE) are lacking. We aimed to clarify the clinical impact of VE and reveal the long-term incidence and mortality of gastrointestinal rebleeding. METHODS: This prospective study included 228 cirrhotic patients who underwent secondary prophylaxis for variceal bleeding and achieved VE through a systematic procedure we proposed as endoscopic sequential therapy (EST). Rebleeding rates before and after VE were compared and cumulative incidence of rebleeding and mortality were calculated using the Kaplan-Meier method. A logistic regression model and P for trend were used to investigate the optimal time limit for VE. RESULTS: During a median (interquartile range) follow-up duration of 33.0 (23.0-48.75) months, rebleeding was identified in 28 patients (12.3%) after VE and in 27 patients (11.8%) during endoscopic sessions. The cumulative incidence of rebleeding before and after VE was 8.4% and 1.8% at 6 months, and 14.9% and 4.0% at 1 year respectively (P<0.001). The long-term incidence of all-cause/variceal rebleeding following VE was 10.4%/9.1%, and 31.5%/23.5% at 2 and 5 years respectively. Eleven patients (4.8%) died and the 5-year mortality was 9.3%. VE achieved within 6 months was associated with fewer rebleeding events compared to VE achieved after 6 months (5.5% vs. 20.0%, P=0.002), while logistic regression revealed an overall increasing trend in the odds ratio of rebleeding (vs. patients with VE time ≤6 months) for patients with 6< VE time ≤12 months and VE time >12 months (P for trend <0.001). CONCLUSIONS: VE further reduces rebleeding based on routine endoscopic prophylaxis and improves long-term prognosis. VE within 6 months seems to be the optimal timing and should therefore be advocated. 2021 Annals of Translational Medicine. All rights reserved.
BACKGROUND: Endoscopic therapy has been widely applied to prevent variceal rebleeding, but data addressing the effect of endoscopic variceal eradication (VE) are lacking. We aimed to clarify the clinical impact of VE and reveal the long-term incidence and mortality of gastrointestinal rebleeding. METHODS: This prospective study included 228 cirrhotic patients who underwent secondary prophylaxis for variceal bleeding and achieved VE through a systematic procedure we proposed as endoscopic sequential therapy (EST). Rebleeding rates before and after VE were compared and cumulative incidence of rebleeding and mortality were calculated using the Kaplan-Meier method. A logistic regression model and P for trend were used to investigate the optimal time limit for VE. RESULTS: During a median (interquartile range) follow-up duration of 33.0 (23.0-48.75) months, rebleeding was identified in 28 patients (12.3%) after VE and in 27 patients (11.8%) during endoscopic sessions. The cumulative incidence of rebleeding before and after VE was 8.4% and 1.8% at 6 months, and 14.9% and 4.0% at 1 year respectively (P<0.001). The long-term incidence of all-cause/variceal rebleeding following VE was 10.4%/9.1%, and 31.5%/23.5% at 2 and 5 years respectively. Eleven patients (4.8%) died and the 5-year mortality was 9.3%. VE achieved within 6 months was associated with fewer rebleeding events compared to VE achieved after 6 months (5.5% vs. 20.0%, P=0.002), while logistic regression revealed an overall increasing trend in the odds ratio of rebleeding (vs. patients with VE time ≤6 months) for patients with 6< VE time ≤12 months and VE time >12 months (P for trend <0.001). CONCLUSIONS: VE further reduces rebleeding based on routine endoscopic prophylaxis and improves long-term prognosis. VE within 6 months seems to be the optimal timing and should therefore be advocated. 2021 Annals of Translational Medicine. All rights reserved.
Authors: Joo Ha Hwang; Amandeep K Shergill; Ruben D Acosta; Vinay Chandrasekhara; Krishnavel V Chathadi; G Anton Decker; Dayna S Early; John A Evans; Robert D Fanelli; Deborah A Fisher; Kimberly Q Foley; Lisa Fonkalsrud; Terry Jue; Mouen A Khashab; Jenifer R Lightdale; V Raman Muthusamy; Shabana F Pasha; John R Saltzman; Ravi Sharaf; Brooks D Cash Journal: Gastrointest Endosc Date: 2014-08 Impact factor: 9.427
Authors: Dhiraj Tripathi; Adrian J Stanley; Peter C Hayes; David Patch; Charles Millson; Homoyon Mehrzad; Andrew Austin; James W Ferguson; Simon P Olliff; Mark Hudson; John M Christie Journal: Gut Date: 2015-04-17 Impact factor: 23.059