关键词: 肝硬化, 食管胃静脉曲张出血, 床旁急诊内镜, 效果, 再出血

Abstract: Objective To evaluate the outcome of bedside urgent endoscopic treatment and risk factors for postoperative rebleeding in patients with moderate-to-severe esophagogastric variceal hemorrhage. Methods One hundred and sixty-eight patients with moderate-to-severe esophagogastric variceal bleeding who received bedside emergency endoscopic treatment in the intensive care unit (ICU) of Shangqiu First People′s Medical Hospital from June 2020 to June 2023 were retrospectively analyzed. The patients were divided into two groups according to the operative modality: 79 cases in the endoscopic sleeve treatment group (EVL group) and 89 cases in the endoscopic sleeve sequential tissue adhesive injection group (Combined group). The treatment efficacy and prognosis of different operative modalities were compared. Univariate and multivariate regression analyses were used to further explore the risk factors associated with postoperative rebleeding. Receiver operating characteristic (ROC) curves were drawn to evaluate their predictive value for rebleeding. Results In 168 patients enrolled in these studies, the rate of successful hemostasis by bedside emergency endoscopy was 94.60% (159/168), and the difference between the two commonly used endoscopic treatment procedures in terms of hemostasis success rate, hospitalization time, total effective rate of treatment, rebleeding rate at 1 month, 3 months, and 6 months post operation, and mortality rate was not significant when comparing the two types of endoscopic treatment procedures (P>0.05), The duration of hemostasis in patients in the EVL group (0.82±0.20) h was shorter than that in the combined group (0.89±0.25) h, with a significant difference in comparison between the groups (P<0.05); endoscopic follow-up revealed that 41 patients in the combined group developed postoperative deglutitional ulcers/bleeding, and the ulcers were deep and large; The rebleeding rate within 3 months after successful hemostasis by emergency endoscopy was 30.8% (49/159), and the results of univariate analysis showed that smoking, shock index, platelet (PLT), prothrombin time (PT), prothrombin activity (PTA), albumin (Alb), portal vein thrombus (PVT), ascites, hepatic encephalopathy, MELD-Na score, Child-pugh classification, and varicose vein score showed statistically significant differences between the two groups (P<0.05) , The results of multifactorial analysis showed that Child-pugh grade C [OR=6.030, 95% CI: 1.558~23.347, P=0.009], PVT [OR=4.388, 95% CI: 1.375~14.006, P=0.013] were the independent risk factors for rebleeding within 3 months after endoscopic sequential treatment, Alb [OR=0.820, 95% CI: 0.706~0.954, P=0.010], and PLT [OR=0.970, 95% CI: 0.951~0.989, P=0.003] were protective factors for rebleeding within 3 months; the area under the curve (AUC) of the four combined to predict rebleeding was 0.873 (95% CI:0.815 to 0.931), with a sensitivity of 73.50% and a specificity of 89.10%. Conclusion Bedside emergency endoscopy can effectively control acute bleeding in patients with moderate-to-severe esophagogastric varices in the intensive care unit (ICU); EVL and endoscopic combined treatment of acute esophagogastric variceal hemorrhage have comparable efficacy in the near future, EVL can obviously shorten the endoscopic hemostasis time and has a small postoperative vascular ulcer surface, which is warranted for further usage in patients with moderate-to-severe esophagogastric variceal bleeding who need emergency hemostasis in ICUs; Child-pugh Grade C, Alb, PLT, and PVT were all associated with rebleeding risk within 3 months after emergency endoscopic hemostasis, and the combination of all four was effective in predicting the risk of rebleeding after endoscopic sequential therapy.

Key words: Cirrhosis, Esophagogastric varices, Bedside emergency endoscopy, Outcome, Rebleeding