Comparison of Outcomes From Sequential Endoscopic Therapy in 60 Patients With Cirrhosis and Esophagogastric Varices Treated at a Provincial and a Tertiary District Hospital.

BACKGROUND This retrospective study aimed to compare outcomes from sequential endoscopic therapy using a planned, multi-stage eradication approach with combined endoscopic techniques in 60 patients with cirrhosis and esophagogastric varices (EGV) treated at a provincial and a tertiary district hospital. MATERIAL AND METHODS Patients receiving secondary prophylaxis of EGV at Pidu District People's Hospital (district tertiary hospital, group A) and Sichuan Provincial People's Hospital (provincial tertiary hospital, group B) between June 1, 2022, and June 30, 2024, were retrospectively included. Group B exhibited more severe baseline disease, including larger portal vein and spleen sizes. Follow-ups at 1, 3, 6, and 12 months assessed clinical symptoms, efficacy, treatment modalities, complications, and compliance. RESULTS A total of 60 patients were included, with 30 in group A and 30 in group B. Both groups achieved significant 12-month endoscopic improvements. Severe EGV decreased markedly in group A (73.33% to 6.67%) and group B (83.33% to 20.00%). The red color sign (Rc+) prevalence decreased in group A (96.43% to 11.11%) and group B (93.10% to 34.78%). Group B exhibited reduced mean variceal diameter (1.03 to 0.40 cm) and decreased ascites. Despite differences in specific endoscopic approaches and patient follow-up adherence, the 12-month incidence of major complications was comparable between groups. CONCLUSIONS Sequential endoscopic therapy demonstrated comparable efficacy and safety in both settings, supporting the safe decentralization of EGV management. However, notable disparities in treatment modality and compliance were observed; thus, future initiatives should prioritize unifying technical training and enhancing patient adherence systems to optimize long-term outcomes.