Author:
Shibata K,Yokoyama K,Yamauchi R,Matsumoto K,Himeno S,Nagata T,Higashi T,Kitaguchi T,Fukuda H,Tsuchiya N,Fukunaga A,Takata K,Tanaka T,Takeyama Y,Shakado S,Sakisaka S,Hirai| F
Abstract
Background and study aims: This study evaluated the long-
term outcomes of mainly endoscopic hemostatic therapy for
gastrointestinal variceal bleeding and of the transition of hemostatic
therapy.
Patients and methods: Among 1,163 patients treated for
gastrointestinal varices between April 2006 and June 2020, a total
of 125 patients who underwent emergency hemostatic therapy
were enrolled. Survival rates and secondary evaluation points were
analyzed. Additionally, patients were classified into two groups:
the previous and latter term. Patients’ background, therapeutic
method, and treatment results were compared between the groups.
Results: 94.4% had cirrhosis. The average Child-Pugh score
was 8.90. Successful primary hemostasis rate was 98.4%, and
5.6% died within 2 weeks, all with a Child-Pugh score ≥9. The
respective 1- and 5-year survival rates for Child-Pugh grade
A/B were 81.3% and 55.4%, while those for Child-Pugh grade C
were 58.1% and 17.8%. Child-Pugh grade C or hepatocellular
carcinoma was significantly associated with poor prognosis. In
total, 21.6% experienced variceal re-bleeding; 62.9% of these cases
were triggered by continued alcohol consumption. There was no
significant difference in survival between patients with and without
variceal re-bleeding and in post-treatment survival between the
previous and latter terms. In the latter term, the number of cases
caused by continued alcohol consumption significantly increased.
Conclusions: Multidisciplinary treatment and continuation of
proper management after hemostatic therapy for variceal bleeding
are crucial. Continued alcohol consumption leads to variceal
bleeding and re-bleeding; its proper management, including alcohol
abstinence, is one of the major challenges left in the post-direct-
acting antivirals era.