Clinical effect of emergency gastroscopic ligation,sclerotherapy,and tissue adhesive injection in treatment of esophagogastric junctional variceal bleeding

Objective To investigate the clinical effect of endoscopic variceal ligation( EVL),endoscopic injection sclerotherapy( EIS),and tissue adhesive injection in the treatment of esophagogastric junctional variceal bleeding,and to provide a reference for reasonable selection of different hemostasis methods. Methods A total of 1264 patients with liver cirrhosis and esophagogastric junctional variceal bleeding who underwent emergency gastroscopic hemostasis in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from June 2017 to June 2019 were enrolled and divided into EVL,EIS,HI groups based on the method of emergency gastroscopic hemostasis. These groups were compared in terms of success rate of operation,success rate of hemostasis,early rebleeding rate,and postoperative complications. The patients were also divided into groups based on bleeding site,and the success rates of different hemostasis methods at different sites were compared. An analysis of variance was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results The success rate of EIS and tissue adhesive injection was significantly higher than that of EVL,and the success rate of EIS was significantly higher than that of tissue adhesive injection( χ2= 75. 01,P < 0. 05). Tissue adhesive injection had a significantly higher success rate of hemostasis than EVL and EIS( χ2= 9. 885,P < 0. 05). There was no significant difference in early rebleeding rate between groups( χ2= 0. 29,P = 0. 865). The patients undergoing EVL had a significantly higher incidence rate of aspiration and pneumonia than those undergoing EIS or tissue adhesive injection( χ2= 19. 08,P < 0. 05); the patients undergoing tissue adhesive injection had a significantly higher proportion of patients with postoperative pyrexia than those undergoing EVL or EIS( χ2= 23. 94,P < 0. 05); the patients undergoing EVL or tissue adhesive injection had a significantly higher incidence rate of postoperative retrosternal discomfort than those undergoing EIS( χ2= 19. 56,P < 0. 05). EIS and EVL had a high success rate of hemostasis for the bleeding sites at 1-5 cm above the esophagogastric junction( EGJ); EIS and tissue adhesive injection had a similar success rate of hemostasis for the bleeding sites from 1 cm above the EGJ to 2 cm below the EGJ; tissue adhesive injection had a high success rate of hemostasis for the bleeding sites at 2-5 cm below the EGJ. Conclusion EVL,EIS,and tissue adhesive injection are effective methods for the treatment of esophagogastric junctional variceal bleeding,and the selection of hemostasis method based on the location of bleeding site can improve the outcome of hemostasis.