Outcome of variceal bleeding (VB) in patients with hepatocellular carcinoma (HCC) is unknown. We compared outcomes after VB in patients with and without HCC. ) and 146 without HCC. No differences were observed regarding previous use of prophylaxis, clinical presentation, endoscopic findings, and initial endoscopic treatment. Five-day failure was similar (25% in HCC versus 18% in non-HCC; P 5 0.257). HCC patients had greater 6-week rebleeding rate (16 versus 7%, respectively; P 5 0.025) and 6-week mortality (30% versus 15%; P 5 0.003). Fewer patients with HCC received secondary prophylaxis after bleeding (77% versus 89%; P 5 0.009), and standard combination therapy was used less frequently (58% versus 70%; P 5 0.079). Secondary prophylaxis failure was more frequent (50% versus 31%; P 5 0.001) and survival significantly shorter in patients with HCC (median survival: 5 months versus greater than 38 months in patients without HCC; P < 0.001). Lack of prophylaxis increased rebleeding and mortality. On multivariate analysis Child-Pugh score, presence of HCC, portal vein thrombosis, and lack of secondary prophylaxis were predictors of death. Conclusions: Patients with HCC and VB have worse prognosis than patients with VB without HCC. Secondary prophylaxis offers survival benefit in HCC patients. (HEPATOLOGY 2013;58:2079-2088
HVPG and albumin are independent predictors of clinical decompensation in patients with compensated CHC-related cirrhosis irrespective of the existence of varices.
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