Abstract:

Objective To investigate the factors influencing gastrointestinal bleeding associated with esophagogastric fundal varices bleeding （EGVB） in patients with liver cirrhosis 5 years after endoscopic treatment. Methods A retrospective enrollment was conducted on 181 patients with liver cirrhosis who underwent endoscopic treatment with EGVB at the First Affiliated Hospital of University of Science and Technology of China from February 2017 to May 2019， followed up for a minimum duration of 5 years. The demographic characteristics including gender， age， etiology of liver cirrhosis （viral， alcoholic， autoimmune， others）， presence of ascites， hepatic encephalopathy severity （none， stage 1 ~ 2， stage 3）， portal vein thrombosis status， occurrence of liver cancer or portal hypertensive gastric disease along with other complications were recorded. Additionally， peripheral blood indexes ［aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， white blood cell count （WBC）， total bilirubin （TBIL）， albumin （ALB）， platelet count （PLT）］， prothrombin time parameters ［prothrombin time （PT） and prothrombin time international normalized ratio（PTINR）］， portal vein diameter and splenic vein diameter measurements as well as Child grade assessment were collected alongside sequential treatment details and rebleeding time. According to the occurrence of rebleeding within 5 years after endoscopic treatment， the 181 cases were divided into two groups： the non?rebleeding group （n = 124） and the rebleeding group （n = 57）. Univariate and multivariate analyses were conducted to identify risk factors associated with rebleeding within 5 years after endoscopic treatment. Additionally， Kaplan?Meier analysis was performed to assess the cumulative bleeding rate at 1， 3， and 5 years. Results The results of both univariate analysis and binary logistic regression analysis revealed that elevated TBIL levels and increased portal vein diameter were significant risk factors for rebleeding within 5 years following endoscopic treatment in patients with EGVB （P < 0.05）. The Kaplan?Meier curve demonstrated that out of the 181 patients， there were 41 cases of cumulative bleeding within 1 year， 54 cases within 3 years， and 57 cases within 5 years， resulting in cumulative bleeding rates of 22.65%， 29.83%， and 31.49% respectively. Conclusions The long?term rebleeding rate remains elevated following endoscopic treatment of EGVB in cirrhotic patients， with TBIL levels and portal vein diameter identified as independent risk factors for long?term rebleeding after endoscopic treatment of EGVB in liver cirrhosis. Therefore， patients with higher TBIL levels and/or cirrhosis should be given priority for endoscopic treatment of EGVB.

Key words: esophageal gastric varices, endoscope, risk factors, rebleeding