Comparison of outcomes in patients at high risk for recurrent gastroesophageal variceal bleeding treated by EUS-guided cyanoacrylate injection for secondary prophylaxis or conventional endoscopic cyanoacrylate injection for index bleeding alone
Refereed conference paper presented and published in conference proceedings


引用次數
替代計量分析
.

其它資訊
摘要Background: Patients with hepatocellular carcinoma (HCC) or other malignancies + portal vein thrombosis (PVT) are at high risk for recurrent variceal bleeding. Rebleeding rate remains high (28 - 42%) in patients with HCC and esophageal variceal (EV) bleeding treated by endoscopic cyanoacrylate (CYA) injection or band ligation. Recent evidence suggested secondary prophylaxis (SP) for variceal bleeding may improve outcomes in patients with HCC, but the optimal approach is not well defined. This study aims to compare outcomes in patients at high risk for recurrent gastroesophageal variceal bleeding treated by EUS-guided CYA injection for SP and conventional CYA injection for index bleeding alone.

Methods: From 2014-2016, consecutive patients with HCC +/-PVT, or non-HCC malignancy +PVT presenting with gastroesophageal variceal bleeding within 12 weeks were recruited for EUS-CYA for SP. EV and GV were assessed on EUS for size and vascular flow. Varices ≥ 3mm were treated by EUS-CYA via a 19G needle with linear echoendoscope. Doppler was used for real-time confirmation of variceal obliteration. Patients were followed for 6 months after EUS or till death, with follow-up EUS at day 90 and 180. A historical control group of HCC patients who underwent conventional EGD-CYA for index GV or EV bleeding alone was identified in a prospective GI bleed database from 2009-2013 for comparison. Outcome measures are death-adjusted cumulative incidence of rebleeding at 30-day and 90-day, and procedure related complications.

Results: 23 patients (mean age 64+/-9; 87.0% male) underwent EUS-CYA for SP during the study period, while 33 HCC patients (mean age 59+/-10, 90.9% male) who underwent EGD-CYA for index GV or EV bleeding alone were identified as historical controls. In the EUS-CYA for SP group, 20 patients had HCC +cirrhosis (85.0% also with PVT), while the other 3 patients had non-HCC malignancy +PVT. Majority of the HCC patients in the EUS-CYA for SP group and the EGD-CYA control group had Barcelona Clinic Liver Cancer (BCLC) stage C disease (85.0% vs 75.8%, p=0.421) and Child-Pugh class B cirrhosis (55.0% vs 71.4%, p=0.241). 13 OV, 6 GV, and 4 OV+GV were treated by EUS-CYA for SP. 52.2% of patients in the EUS-CYA for SP group had varices ≥ 5mm on EUS. Both the 30-day and 90-day death adjusted cumulative incidence of rebleeding were significantly lower in the EUS-CYA for SP group when compared to EGD-CYA control group (13% vs 42% at 30-day, p=0.023 and 22% vs 61% at 90-day, p=0.005, respectively). No pulmonary CYA embolism (as indicated by lipiodol on chest x-ray) was found in either group.

Conclusion: In this study, EUS-CYA for SP was found to significantly reduce both the 30-day and 90-day death adjusted cumulative incidence of rebleeding in patients at high risk for recurrent gastroesophageal variceal bleeding when compared to EGD-CYA for index bleeding alone.
著者Tang RS, Wong JC, Kyaw MH, Teoh AY, Tse YK, Lam TY, Wu JC, Lau JY
會議名稱Digestive Disease Week Conference
會議開始日06.05.2017
會議完結日09.05.2017
會議地點Chicago
會議國家/地區美國
會議論文集題名Gastrointestinal Endoscopy
出版年份2017
月份5
卷號85
期次5S
頁次AB475 - AB476
國際標準期刊號0016-5107
電子國際標準期刊號1097-6779
語言美式英語
關鍵詞EUS, varices, glue injection

上次更新時間 2020-21-11 於 02:21