Rates of recurrent variceal bleeding are low with modern esophageal banding strategies: a retrospective cohort study

Branch‐Elliman, Westyn; Perumalswami, Ponni V.; Sled, Sarah M; Flamm, Steven L.

doi:10.3109/00365521.2015.1027263

Cited by 8 publications

(6 citation statements)

References 37 publications

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“…Several studies have examined the outcome of esophageal variceal bleeding treated with EVL, but most focused on patients whose condition had stabilized. There are limited data available on the long‐term course after initial EVL for acute severe variceal bleeding in the emergency setting.…”

Section: Introductionmentioning

confidence: 99%

Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long‐term cohort study

Cho

Nagata

Shimbo

et al. 2016

Hepatology Research

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This study revealed more than 50% cumulative rebleeding and mortality in the 5-year period after endoscopic variceal ligation for esophageal variceal bleeding in an emergency setting. Child-Pugh C, alcoholic liver cirrhosis, and no follow-up endoscopy increased the risk of rebleeding; Child-Pugh C, coexistence of hepatocellular carcinoma, and no follow-up endoscopy increased the risk of mortality.

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Section: Introductionmentioning

confidence: 99%

Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long‐term cohort study

Cho

Nagata

Shimbo

et al. 2016

Hepatology Research

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“…Although the overall percentages before and after eradication were similar in our study, the beneficial impact became marked when taking the follow-up period into account, and an additional 10% decrease in the one-year rebleeding incidence was observed. On the other hand, most previous studies analysed data on EV alone, while few studies evaluated patients undergoing endoscopic treatment for both EV and coexisting junctional or fundal GV (5,10). Considering that GV occurs in 50% of cirrhotic patients and contributes to 10-20% of variceal bleeding (1,4,21,22), a complete occlusion of both EV and GV achieved by EST in our study was a sound and more ideal endoscopic endpoint than EV eradication alone.…”

Section: Discussionmentioning

confidence: 73%

“…Moreover, the additional long-term benefit following VE achievement has not been studied. Meanwhile, a standard endoscopic protocol integrating treatment for both esophageal varices (EV) and gastric varices (GV) has not been established (5,10). Therefore, our study aimed to clarify the impact of endoscopic VE on rebleeding and mortality in cirrhotic patients undergoing secondary prophylaxis and proposes a systematic procedure, endoscopic sequential therapy (EST), highlighting complete eradication of EV and GV.…”

Section: Introductionmentioning

confidence: 99%

Impact of variceal eradication on rebleeding and prognosis in cirrhotic patients undergoing secondary prophylaxis

et al. 2021

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Background: Endoscopic therapy has been widely applied to prevent variceal rebleeding, but data addressing the effect of endoscopic variceal eradication (VE) are lacking. We aimed to clarify the clinical impact of VE and reveal the long-term incidence and mortality of gastrointestinal rebleeding.Methods: This prospective study included 228 cirrhotic patients who underwent secondary prophylaxis for variceal bleeding and achieved VE through a systematic procedure we proposed as endoscopic sequential therapy (EST). Rebleeding rates before and after VE were compared and cumulative incidence of rebleeding and mortality were calculated using the Kaplan-Meier method. A logistic regression model and P for trend were used to investigate the optimal time limit for VE.Results: During a median (interquartile range) follow-up duration of 33.0 (23.0-48.75) months, rebleeding was identified in 28 patients (12.3%) after VE and in 27 patients (11.8%) during endoscopic sessions. The cumulative incidence of rebleeding before and after VE was 8.4% and 1.8% at 6 months, and 14.9% and 4.0% at 1 year respectively (P<0.001). The long-term incidence of all-cause/variceal rebleeding following VE was 10.4%/9.1%, and 31.5%/23.5% at 2 and 5 years respectively. Eleven patients (4.8%) died and the 5-year mortality was 9.3%. VE achieved within 6 months was associated with fewer rebleeding events compared to VE achieved after 6 months (5.5% vs. 20.0%, P=0.002), while logistic regression revealed an overall increasing trend in the odds ratio of rebleeding (vs. patients with VE time ≤6 months) for patients with 6< VE time ≤12 months and VE time >12 months (P for trend <0.001).Conclusions: VE further reduces rebleeding based on routine endoscopic prophylaxis and improves longterm prognosis. VE within 6 months seems to be the optimal timing and should therefore be advocated.

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“…Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 В настоящее время для лечения и профилактики пищеводно-желудочных кровотечений применяются несколько основных вмешательств: селективные и парциальные портокавальные анастомозы, трансъюгулярное внутрипеченочное портосистемное шунтирование (TIPS), эндоскопические вмешательства [7,8]. Чрезъяремное внутрипеченочное портосистемное шунтирование является одной из последних новаторских минимально инвазивных технологий, позволяющей выполнить эффективную декомпрессию портальной системы [9].…”

Section: Summarytreatmentunclassified

Minimally invasive surgical interventions in the treatment and prevention of bleeding from varicose veins of the esophagus and stomach

Котив

Николаевич²,

Дзидзава

et al. 2020

Russian Military Medical Academy Reports

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Treatment and prevention of complications of portal hypertension today is a complex and unsolved problem of hepatosurgery. Mortality from esophageal-gastric bleeding (ESH) of portal genesis ranges from 22 to 100%. The aim of the study is to improve the results of the treatment and prevention of digestive haemorrhage in portal hypertension by optimize using of miniinvasive interventions. A retrospective analysis of the treatment results of 128 patients with cirrhosis of the liver, in which the predominant complication of portal hypertension resulted in bleeding from varicose veins of the esophagus and the stomach, and a high risk of its occurrence or recidivism have been carried out. Gastric laparoscopic devascularization with endoscopic ligation reduces the lethality from esophageal-gastric bleeding, compared to only ligation, for six months after the operation by 21.8% (2 = 2.61; p = 0.106), 25.5% within a year (2 = 2.75; p = 0.091), for two years after the 25.4% operation (2 = 1.47; p = 0.225), for three years 25.5% (2 = 0.43; p = 0.051). There is a statistically reliable lack of differences in the groups of patients after the traditional and endovideoxyric operations of the portocal bypass in terms of the reduction of the degree of VDEV (84.3 and 86.7%), which indicates the equivalent effect of the performed operations. A comparative study of selective portocaval anastomoses and TIPS found no reliable difference in the frequency of recurrent bleeding. Post-shunt encephalopathy, thrombosis, and stenosis of the shunt were more common in the transjugular intrahepatic portosistame shunt (p 0.001), and survival in the group of surgical anastomosis was superior to that of TIPS. The above data indicate that the use of endoscopic, endovascular, endovision and endovision surgery, extracorporeal miniinvasive techniques is an integral part of the complex surgical treatment of patients with portal hypertension. Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 figs, bibliography: 14 refs).

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Rates of recurrent variceal bleeding are low with modern esophageal banding strategies: a retrospective cohort study

Abstract: Aggressive EBL yields a low rate of re-bleeding when compared to standard practice. Secondary prophylaxis with aggressive EBL should be a consideration for patients following a sentinel bleeding event.

Cited by 8 publications

References 37 publications

Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long‐term cohort study

Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long‐term cohort study

Impact of variceal eradication on rebleeding and prognosis in cirrhotic patients undergoing secondary prophylaxis

Minimally invasive surgical interventions in the treatment and prevention of bleeding from varicose veins of the esophagus and stomach

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