Influence of gastroesophageal flap valve on esophageal variceal bleeding in patients with liver cirrhosis

Abstract

Objectives: Esophageal variceal bleeding can be fatal in patients with liver cirrhosis. The aim of this study was to investigate the relationship between gastroesophageal flap valve (GEFV) and esophageal variceal bleeding. Methods: Subjects were cirrhotic patients with endoscopically diagnosed esophageal varices treated at our hospital between 2005 and 2019, excluding those with F3 form and red color (RC) signs at first endoscopy. Sixty-five patients with normal GEFV (Hill grade I or II) and 42 with abnormal GEFV (Hill grade III or IV) were enrolled. Propensity score matching eliminated the baseline differences, resulting in a sample size of 30 patients per cohort. The primary endpoint was esophageal variceal bleeding, and the secondary endpoint was variceal bleeding or appearance of RC sign. We analyzed the cumulative incidences and predictors of each endpoint. Results: The 3-, 5-, and 10-year cumulative incidences of the primary endpoints were all 3.4% in the normal GEFV group, and 19.0%, 24.6% and 34.0% in the abnormal GEFV group, respectively (log-rank P = 0.011). Cumulative incidence of the secondary endpoint was 13.8%, 33.1% and 39.2% in the normal GEFV group, and 42.2%, 54.6% and 84.9% in the abnormal GEFV group, respectively (log-rank P = 0.001). In multivariate Cox regression analyses, hazard ratios of abnormal GEFV of the primary and secondary endpoints were 12.79 (95% confidence interval 1.331-122.8) and 3.600 (1.653-7.840), respectively. Conclusions: Abnormal GEFV was an independent risk factor for esophageal variceal bleeding and appearance of RC sign.

Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

“…EVB patients have a high risk of rebleeding and death after bleeding control ( 19 ). If the EVB patients do not receive secondary preventive treatment for 1–2 years, the rebleeding rate is elevated to about 60%, and the mortality rate is 33% ( 20 ). At present, EVL and EIS are indispensable in the endoscopic treatment of the secondary prevention of EVB.…”

Trends of hospitalisation among new admission inpatients with oesophagogastric variceal bleeding in cirrhosis from 2014 to 2019 in the Affiliated Hospital of Southwest Medical University: a single-centre time-series analysis

“…Almost 90% of patients with liver cirrhosis eventually develop portal hypertension 2. Oesophagogastric variceal bleeding (EGVB) caused by portal hypertension is the most common complication of cirrhosis and is one of the most common digestive system emergencies, with high risk and high mortality, requiring urgent hospital admission and long-term hospital stay 3 4. Although multiple procedures were available to control bleeding, the associated mortality currently accounted for approximately 10%–20% 5.…”

“… 2 Oesophagogastric variceal bleeding (EGVB) caused by portal hypertension is the most common complication of cirrhosis and is one of the most common digestive system emergencies, with high risk and high mortality, requiring urgent hospital admission and long-term hospital stay. 3 4 Although multiple procedures were available to control bleeding, the associated mortality currently accounted for approximately 10%–20%. 5 EGVB in cirrhosis occurs easily and the disease burden associated with multiple hospitalisations correspondingly increases.…”

Abnormal gastroesophageal flap valve: a predictor of recurrent variceal haemorrhage

“…On Multivariate analysis, abnormal GEFV (OR 7.25, 95% CI 3.27– 16.08, P=0.001) and large varices (OR 5.70, 95% CI 2.45– 13.20, P=0.001) were independent predictors for recurrent esophageal variceal bleeding. 1 2…”