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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 11
Nov.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(11): 2569-2574

Risk factors for rebleeding after endoscopic selective variceal devascularization in patients with hepatitis B cirrhosis and acute variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2021.11.017

  • Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

Research funding:

Capital Medical University Affiliated Beijing Ditan Hospital Young Talent Development Fund "Sprout" Project (DTMY201807);

Capital Foundation for Clinical Characteristic Applied Research Projects (Z181100001718084);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0404)

  • Received Date: 2021-03-23
  • Accepted Date: 2021-05-11
  • Published Date: 2021-11-20
    Abstract
  •   Objective  To investigate the rebleeding rate after endoscopic selective variceal devascularization (ESVD) and the predictive factors for rebleeding in patients with hepatitis B cirrhosis and esophageal variceal bleeding (EVB).  Methods  The patients with hepatitis B cirrhosis and EVB who attended Beijing Ditan Hospital, Capital Medical University, from October 2010 to December 2019 and underwent ESVD for the first time were enrolled, and a total of 442 patients were screened out based on inclusion and exclusion criteria. Routine clinical indices, laboratory markers, imaging findings, and endoscopic findings were compared between patients, and the patients were followed up to observe rebleeding. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to describe rebleeding and survival status, and a Cox regression analysis was used to determine the independent risk factors for variceal rebleeding.  Results  The 1-, 2-, 3-, 4-, and 5-year cumulative rebleeding rates after first ESVD treatment were 25.11%, 33.94%, 39.82%, 42.08%, and 45.02%, respectively. The univariate analysis showed that age, systolic pressure, duration of antiviral therapy ≥1 year, ascites, white blood cell count, neutrophil, and direct bilirubin were associated with rebleeding (all P < 0.05), and the multivariate analysis showed that duration of antiviral therapy ≥1 year (hazard ratio [HR]=0.504, 95% confidence interval [CI]: 0.357-0.711, P < 0.001) and ascites (HR=1.424, 95%CI: 1.184-1.714, P < 0.001) were independent influencing factors for variceal rebleeding.  Conclusion  ESVD has a low rebleeding rate in the treatment of hepatitis B cirrhosis with EVB, and presence of ascites and a short duration of antiviral therapy are independent risk factors for rebleeding after treatment.

     

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