Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study

Frontiers in Medicine

Haiming Fang¹  Jia Li²  Shuang Li²  Lili Zhao²  Xin Yong³  Chaohui He⁴  Yanfei Fang⁵  Pan Jiang⁵  Min Gao⁵  Shenglin Qi⁶  Jinlun Bao⁷  Song He⁸  Xing Wang⁹  Bin Wu⁹  Yuening Zhang^1,10  Yongfeng He^1,11  Xingsi Qi^1,12  Lijun Peng^1,13  Bin Ye^1,14  Guo Zhang^1,15  Wei Wu^1,16  Rui Ji^1,17  Ying Song^1,18  Xiqiao Zhou^1,19  Yang Bo^2,20  Tong Dang^2,21  Jing Zeng^2,22  Wei Yan^2,23  Jiangbo Shao^2,24  Wei Wei^2,25  Xiaoyan Tan^2,26  Hongjiang Li^2,27  Jianping Hu^2,28  Mingming Deng^2,29  Ye Gu^3,31  Liyao Zhang^3,31  Yan Wang^3,31  Yunhai Wu^3,31  Aimin Liu^3,32  Dongli Xia^3,32  Zhenbei Liu^3,32  Shengjuan Hu^3,33  Lili Yuan^3,34  Ping Cao^3,34  Huiling Xiang^3,35  Chang’en Liu^3,35  Fengmei Wang^3,35  Jia Lian^3,35  Yanna Liu^3,36  Wenhui Zhang^3,37  Mengmeng Li^3,37  Yanling Wang^3,37  Xiaolong Qi^3,38  Yifei Huang^3,38  Chuan Liu^3,38 

[1] 0Department of Gastroenterology and Hepatology, The Second Hospital of Anhui Medical University, Hefei, China;0Department of Gastroenterology and Hepatology, Tianjin Second People’s Hospital, Tianjin, China;0Gastroenterology, General Hospital of Western Theater Command, Chengdu, China;1Department of Gastroenterology and Endoscopy, The Fifth Affiliated Zhuhai Hospital of Zunyi Medical University, Zhuhai, China;1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China;1Department of Hepatology, Dalian Sixth People’s Hospital, Dalian, China;2Department of Gastroenterology, Shannan People’s Hospital, Shannan, China;2Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China;2Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;3Center of Hepatology and Gastroenterology, Beijing You’an Hospital, Capital Medical University, Beijing, China;3Department of Gastroenterology, Endoscopic Center, Ankang Central Hospital, Ankang, China;3Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China;4Department of Gastroenterology, Linyi People’s Hospital, Linyi, China;4Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China;4The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China;5Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China;5Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China;5Department of Gastroenterology, Xi’an GaoXin Hospital, Xi’an, China;6Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China;6Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China;6Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China;7Department of Emergency, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China;7Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;7Department of Liver Disease, The Third People’s Hospital of Zhenjiang, Zhenjiang, China;8Department of Gastroenterology, Jinhua Hospital, Jinhua, China;8Department of Gastroenterology, Maoming People’s Hospital, Maoming, China;8Department of Hepatology, Baoding People’s Hospital, Baoding, China;9Department of Gastroenterology, First People’s Hospital of Yinchuan City, Yinchuan, China;9Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China;Beijing Shijitan Hospital, Beijing, China;Department of Critical Care Medicine, The Sixth People’s Hospital of Shenyang, Shenyang, China;Department of Gastroenterology, Chongqing Fuling Central Hospital, Chongqing, China;Department of Gastroenterology, Endoscopic Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China;Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China;Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China;Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China;Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China;Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China;

关键词: liver cirrhosis;    portal hypertension;    emergency endoscopy;    endoscopic injection sclerotherapy;    endoscopic variceal ligation;   

DOI  :  10.3389/fmed.2022.872881

来源: DOAJ

【 摘 要 】

Background and AimsEmergency endoscopy is recommended for patients with acute esophageal variceal bleeding (EVB) and their prognosis has improved markedly over past decades due to the increased specialization of endoscopic practice. The study aimed to compare outcomes following emergency endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) in cirrhotic patients with acute EVB.MethodsCirrhotic patients with acute EVB who underwent emergency endoscopy were retrospectively enrolled from 2013 to 2020 across 34 university hospitals from 30 cities. The primary outcome was the incidence of 5-day rebleeding after emergency endoscopy. Subgroup analysis was stratified by Child-Pugh class and bleeding history. A 1:1 propensity score matching (PSM) analysis was performed.ResultsA total of 1,017 and 382 patients were included in EIS group and EVL group, respectively. The 5-day rebleeding incidence was similar between EIS group and EVL group (4% vs. 5%, P = 0.45). The result remained the same after PSM (P = 1.00). Among Child-Pugh class A, B and C patients, there were no differences in the 5-day rebleeding incidence between the two groups after PSM (P = 0.25, 0.82, and 0.21, respectively). As for the patients with or without bleeding history, the differences between EIS group and EVL group were not significant after PSM (P = 1.00 and 0.26, respectively).ConclusionThe nationwide cohort study indicates that EIS and EVL are both efficient emergency endoscopic treatment strategies for acute EVB. EIS should not be dismissed as an economical and effective emergency endoscopic treatment strategy of acute EVB. ClincialTrials.gov number NCT04307264.

【 授权许可】

Unknown