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

Frontiers in Medicine

article

Yifei Huang¹  Wenhui Zhang²  Huiling Xiang⁴  Yanna Liu⁵  Lili Yuan⁶  Liyao Zhang⁷  Shengjuan Hu⁸  Dongli Xia⁹  Jia Li^1,10  Min Gao^1,11  Xing Wang^1,12  Xingsi Qi^1,13  Lijun Peng^1,14  Ying Song^1,15  Xiqiao Zhou^1,16  Jing Zeng^1,17  Xiaoyan Tan^1,18  Mingming Deng^1,19  Haiming Fang^2,20  Shenglin Qi^2,21  Song He^2,22  Yongfeng He^2,23  Bin Ye^2,24  Wei Wu^2,25  Tong Dang^2,26  Jiangbo Shao^2,27  Wei Wei^2,28  Jianping Hu^2,29  Xin Yong^3,30  Chaohui He^3,31  Jinlun Bao^3,32  Yuening Zhang^3,33  Guo Zhang^3,34  Rui Ji^3,35  Yang Bo^3,36  Wei Yan^3,37  Hongjiang Li^3,38  Yanling Wang³  Mengmeng Li³  Fengmei Wang⁴  Jia Lian⁴  Chang’en Liu⁴  Ping Cao⁶  Zhenbei Liu⁹  Aimin Liu⁹  Lili Zhao^1,10  Shuang Li^1,10  Yunhai Wu⁷  Ye Gu⁷  Yan Wang⁷  Yanfei Fang^1,11  Pan Jiang^1,11  Bin Wu^1,12  Chuan Liu¹  Xiaolong Qi¹ 

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

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

DOI  :  10.3389/fmed.2022.872881

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background and Aims Emergency 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. Methods Cirrhotic 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. Results A 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). Conclusion The 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.

【 授权许可】

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