Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus

Pengpeng DING; Canghai WANG; Li LI; Jianhong CHEN; Xiaobao QI; Yanling WANG; Zheng LU; Wenhui ZHANG; Hong LIU

doi:10.3969/j.issn.1001-5256.2021.01.014

Volume 37 Issue 1

Jan. 2021

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Article Navigation > Journal of Clinical Hepatology > 2021 > 37(1): 68-72

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Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus

DOI: 10.3969/j.issn.1001-5256.2021.01.014

1.
Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
2.
First Liver Cirrhosis Diagnosis and Treatment Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

Received Date: 2020-07-27
Accepted Date: 2020-09-07
Published Date: 2021-01-20

Abstract

Abstract

Objective To investigate the risk factors for failure in emergency endoscopic injection sclerotherapy (EIS) combined with sequential histoacryl injection (HI) for esophagogastric variceal bleeding (EGVB) with portal vein embolus (PVE). Methods A total of 109 EGVB patients with PVE who underwent emergency gastroscopy in Beijing Shijitan Hospital, Capital Medical University, and The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to December 2019 were enrolled, and according to the outcome of hemostatic treatment under emergency gastroscopy, the patients were divided into hemostatic failure group with 28 patients and hemostatic success group with 81 patients. The two groups were compared in terms of general information, varices and bleeding manifestations under gastroscopy, blood biochemical parameters, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the risk factors for hemostatic failure were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a logistic regression analysis was used for multivariate analysis. Results Compared with the hemostatic success group, the hemostatic failure group had significantly higher peripheral white blood cell count (WBC), total bilirubin (TBil), Child-Pugh class, and MELD score (Z=3.794, Z=4.751, χ²=40.104, Z=6.412, all P < 0.001) and significantly lower prothrombin time activity (PTA), albumin (Alb), and cholinesterase (CHE) (t=9.653, Z=3.093, Z=4.092, P < 0.001, P=0.002, and P < 0.001). WBC (odds ratio [OR]=28.543, 95% confidence interval [CI]: 1.285-634.113, P < 0.05), PTA(OR=0.194, 95%CI: 0.045-0.835, P < 0.05), TBil (OR=2.197, 95%CI: 1.004-4.810, P < 0.05), Alb (OR=0.448, 95%CI: 0.209-0.961, P < 0.05), and Child-Pugh class (OR=5.164, 95%CI: 1.307-20.406, P < 0.05) were independent risk factors for hemostatic failure. Conclusion WBC, PTA, TBil, Alb, and Child-Pugh class are independent risk factors for failure in emergency EIS combined with sequential HI in the treatment of EGVB with PVE, and adequate preoperative evaluation and correction may help to improve the success rate of hemostasis.
- Liver Cirrhosis,
- Venous Thrombosis,
- Esophageal and Gastric Varices,
- Hemorrhage,
- Hemostasis, Endoscopic

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Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus

DOI: 10.3969/j.issn.1001-5256.2021.01.014