Journal of clinical and experimental hepatology · 2025
Endovascular Interventions for the Secondary Prophylaxis of Gastric Varices Prevent Rebleeding but May Not Improve Overall Survival: A Real-world Cohort From Two Centers.
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Biswas Sagnik, Kumar Santhosh E, Gupta Sanchita, Bharadwaj Pegatraju K, Swaroop Shekhar, Kb Santhosh B, Sharma Anuradha, Aggarwal Arnav, Arora Umang, Saxena Sarthak, Chavan Amitkumar, Bayye Rajkumar, Agarwal Samagra, Gunjan Deepak, Kumar Rahul, Keshava Shyamkumar N, Gamanagatti Shivanand, Goel Ashish, Shalimar
Аннотация
BACKGROUND: There is limited literature on the long-term outcomes of patients with cirrhosis following an index gastric variceal (GV) hemorrhage.
METHODS: Patients with cirrhosis and hemorrhage from gastroesophageal varices type-2 (GOV-2) or isolated gastric varices type-1 (IGV-1) from two tertiary care centers over 8 years were retrospectively analyzed. All patients underwent endoscopic cyanoacrylate injection (ECI) for primary hemostasis. Modalities of secondary prophylaxis included endoscopic surveillance and beta-blockers (ECI and BBs), balloon-occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS). The incidence of rebleeding, mortality, and further decompensation among patients receiving ECI and BB was estimated and compared with a propensity score-matched (PSM) cohort of patients undergoing BRTO or TIPS.
RESULTS: Three hundred and fifty-one patients were recruited. Of those 275 received ECI and BB, 54 underwent BRTO, and 22 underwent TIPS. The rebleeding rate at 1 year after ECI and BB was 19.2%, while the 1-year mortality and further decompensation rates were 19.7% and 27.8%, respectively. Rebleeding predominantly occurred from GV (76.1% of cases), with the cumulative 1-, 3-, and 5-year all-cause rebleeding rate among patients receiving ECI alone being 19.2%, 30%, and 35%, respectively. BRTO and TIPS significantly reduced all-cause rebleeding, but were associated with similar rates of further decompensation and mortality compared to ECI and BB in the PSM cohort.
CONCLUSION: BRTO and TIPS significantly reduce all-cause rebleeding as compared to ECI and BB, but their impact on further decompensation and overall survival requires further evaluation in larger cohorts.
METHODS: Patients with cirrhosis and hemorrhage from gastroesophageal varices type-2 (GOV-2) or isolated gastric varices type-1 (IGV-1) from two tertiary care centers over 8 years were retrospectively analyzed. All patients underwent endoscopic cyanoacrylate injection (ECI) for primary hemostasis. Modalities of secondary prophylaxis included endoscopic surveillance and beta-blockers (ECI and BBs), balloon-occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS). The incidence of rebleeding, mortality, and further decompensation among patients receiving ECI and BB was estimated and compared with a propensity score-matched (PSM) cohort of patients undergoing BRTO or TIPS.
RESULTS: Three hundred and fifty-one patients were recruited. Of those 275 received ECI and BB, 54 underwent BRTO, and 22 underwent TIPS. The rebleeding rate at 1 year after ECI and BB was 19.2%, while the 1-year mortality and further decompensation rates were 19.7% and 27.8%, respectively. Rebleeding predominantly occurred from GV (76.1% of cases), with the cumulative 1-, 3-, and 5-year all-cause rebleeding rate among patients receiving ECI alone being 19.2%, 30%, and 35%, respectively. BRTO and TIPS significantly reduced all-cause rebleeding, but were associated with similar rates of further decompensation and mortality compared to ECI and BB in the PSM cohort.
CONCLUSION: BRTO and TIPS significantly reduce all-cause rebleeding as compared to ECI and BB, but their impact on further decompensation and overall survival requires further evaluation in larger cohorts.