Efficacy of Endoscopic Intervention in the Prevention of Portal Genesis Bleedings

Abstract

Objective. To analyze the survival of patients with liver cirrhosis and to assess the effectiveness of endoscopic interventions in the prevention of portal genesis bleedings. Materials and methods. To assess the effectiveness of endoscopic interventions, our study included 449 liver cirrhotic patients with portal hypertension who was admitted with bleeding from varicose veins or the threat of its recurrence for the period from 1996 to 2015. All patients were divided into 2 groups of the study. The main group included 239 patients treated between 2010 and 2015 and the control group consisted of 210 patients in the period from 1996 to 2010. Results. The analysis showed that the percentage of patients without recurrence of bleeding from varicose veins was 27% (33 patients) in the control group and 54.2% (64) in the main group when performing only endoscopic interventions. With the phased tactics of portosystemic shunt performance after endoscopic interventions this figure amounted to 32.4% (45) and 109 (61.6%). In the structure of mortality of patients without cirrhosis in the long-term period (81 patients) with endoscopic interventions recurrence of bleeding were observed in 40.7% (33) cases in the control group and 68.1% (64 of 94) in the main group. In turn, when combined endoscopy and portosystemic shunting in the structure of the patients, without counting deaths from progressive liver cirrhosis, the proportion of absence of recurrence was 45.9% (in 45 of 98 patients) and 71.2% (in 102 out of 153 tracked in the remote period excluding deaths from cirrhosis). In the group of patients that do not carry out any endoscopic intervention and the patients received only conservative therapy only in 3 (10.7%) cases it was possible to avoid recurrence of bleeding, which determines the therapeutic ineffectiveness isolated attempts to reduce the risk of recurrence of hemorrhagic syndrome. Conclusion. Modern possibilities of endoscopic technologies have significantly improved the results of treatment and prevention of varicose bleeding or the threat of its recurrence, and the commitment to the phased tactics, with a combination of minimally invasive and traditional decompressive surgery, allowed to increase the survival rates of patients with 80% to 88% - up to 1 year and from 42% to 64% - to 3 years of follow-up.