Endoscopic treatment or balloon-occluded retrograde transvenous obliteration is safe for patients with esophageal/gastric varices in Child-Pugh class C end-stage liver cirrhosis
- Author:
Keiji YOKOYAMA
1
;
Ryo YAMAUCHI
;
Kumiko SHIBATA
;
Hiromi FUKUDA
;
Hideo KUNIMOTO
;
Kazuhide TAKATA
;
Takashi TANAKA
;
Shinjiro INOMATA
;
Daisuke MORIHARA
;
Yasuaki TAKEYAMA
;
Satoshi SHAKADO
;
Shotaro SAKISAKA
Author Information
- Publication Type:Original Article
- Keywords: Portal hypertension; Liver cirrhosis; Esophageal and gastric varices; Endoscopy; Balloon occlusion
- MeSH: Balloon Occlusion; Bilirubin; Endoscopy; Esophageal and Gastric Varices; Hemorrhage; Humans; Hypertension, Portal; Ligation; Liver Cirrhosis; Liver; Prognosis; Risk Factors; Sclerotherapy; Varicose Veins
- From:Clinical and Molecular Hepatology 2019;25(2):183-189
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: There is a controversy about the availability of invasive treatment for esophageal/gastric varices in patients with Child-Pugh class C (CP-C) end-stage liver cirrhosis (LC). We have evaluated the validity of invasive treatment with CP-C end-stage LC patients. METHODS: The study enrolled 51 patients with CP-C end-stage LC who had undergone invasive treatment. The treatment modalities included endoscopic variceal ligation in 22 patients, endoscopic injection sclerotherapy in 17 patients, and balloon-occluded retrograde transvenous obliteration (BRTO) in 12 patients. We have investigated the overall survival (OS) rates and risk factors that contributed to death within one year after treatment. RESULTS: The OS rate in all patients at one, three, and five years was 72.6%, 30.2%, and 15.1%, respectively. The OS rate in patients who received endoscopic treatment and the BRTO group at one, three, and five years was 67.6%, 28.2% and 14.1% and 90.0%, 36.0% and 18.0%, respectively. The average of Child-Pugh scores (CPS) from before treatment to one month after variceal treatment significantly improved from 10.53 to 10.02 (P=0.003). Three significant factors that contributed to death within one year after treatment included the presence of bleeding varices, high CPS (≥11), and high serum total bilirubin levels (≥4.0 mg/dL). CONCLUSIONS: The study demonstrated that patients with a CPS of up to 10 and less than 4.0 mg/dL of serum total bilirubin levels may not have a negative impact on prognosis after invasive treatment for esophageal/gastric varices despite their CP-C end-stage LC.
