关键词: 门静脉高压, 上消化道出血, 内镜下静脉曲张套扎术, Child-Pugh评分

Abstract: Objective To analyze the effect of on-demand endoscopic treatment on the prevention of gastrointestinal bleeding in elderly patients with liver cirrhosis. Methods A total of 186 elderly patients with liver cirrhosis complicated with upper gastrointestinal bleeding who were treated in the Department of Gastroenterology, Ruijin Hospital North from January 2013 to January 2021 were collected. According to the treatment plan, they were divided into an endoscopic treatment group and a drug treatment group, with 93 cases in each group. All patients in the endoscopic treatment group underwent endoscopic variceal ligation (EVL) for the first time, followed by regular postoperative follow-up and sequential endoscopic treatment in 3～6 months. The patients in the drug treatment group only received drug treatment. The recurrences of bleeding after treatment in these two groups and the risk factors were analyzed. Results Among the 93 patients in the endoscopic treatment group, 13 patients had re-bleeding within half a year after EVL, accounting for 14.0% (13/93); Among the 93 patients in the drug treatment group, 47 patients had rebleeding within half a year, accounting for 50.5% (47/93). There was significant difference in rebleeding rates between the two groups (P<0.05). After one year of follow-up, 7 patients in the endoscopic treatment group had re-bleeding, accounting for 7.5% (7/93); while 27 cases of rebleeding in the drug treatment group, accounting for 29.0% (27/93). There was significant difference between the two groups (P<0.05). However, age, gender, splenectomy and child-Pugh grade had no significant correlation with rebleeding in half a year (P>0.05). Conclusion For elderly patients with upper gastrointestinal bleeding due to liver cirrhosis, on-demand endoscopic treatment is safe and effective. After sequential endoscopic treatment, the recurrent rate of gastrointestinal bleeding significantly lower than those patients with drug treatment alone.

Key words: Portal hypertension, Upper gastrointestinal bleeding, Endoscopic variceal ligation, Child-Pugh scoring