Analysis of prognostic factors in patients with gastric varices after endoscopic treatment.
BACKGROUND
The prognostic factors, including gastric variceal bleeding itself, in patients with gastric varices (GV) after endoscopic treatment remain unclear. The aim of this study was to analyze prognostic factors in patients with GV after endoscopic treatment as well as to evaluate safety and efficacy of our endoscopic treatment.


METHODS
This study enrolled 115 patients who underwent endoscopic treatment for GV between October 1988 and December 2003 using cyanoacrylate and 5% ethanolamine oleate. Successful hemostasis, recurrence rates, rebleeding rates, survival rates, complications and prognostic factors after the treatment were retrospectively reviewed.


RESULTS
Treatment sessions for GV were performed 3.4 +/- 2.5 times. All cases, including 14 emergency cases, were treated successfully. The cumulative recurrence rates at 1, 3 and 5 years after the treatment were 7.0%, 15.6% and 20.0%, respectively, and the cumulative rebleeding rates at 1, 3 and 5 years were 3.5%, 8.7% and 14.8%, respectively. The overall survival rates were 78.3%, 63.7% and 51.5% at 1, 3 and 5 years, respectively. Grade B or C in Child-Pugh classification, emergency or elective cases, and association with hepatocellular carcinoma were identified as significant negative prognostic factors after endoscopic treatment by multivariate analysis. Although several complications were observed, there was no mortality.


CONCLUSIONS
Grade B or C in Child-Pugh classification, emergency or elective situation, and association with hepatocellular carcinoma are negative prognostic factors after endoscopic treatment.
Wakatsuki
Takeru
T
Department of Internal Medicine 2, Fukushima Medical University School of Medicine, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan. wakachan@fmu.ac.jp
Obara
Katsutoshi
K
Irisawa
Atsushi
A
Sakamoto
Hiroaki
H
Kuwana
Toshimitu
T
Takiguchi
Fujio
F
Saito
Ayako
A
Shishido
Hideo
H
Hikichi
Takuto
T
Oyama
Hitoshi
H
Shibukawa
Goro
G
Takagi
Tadayuki
T
Yamamoto
Go
G
Imamura
Hidemichi
H
Takahashi
Yuta
Y
Sato
Ai
A
Sato
Masaki
M
Kasukawa
Reiji
R
Ohira
Hiromasa
H
D000368:Aged; D015331:Cohort Studies; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D016896:Treatment Outcome
D003487:Cyanoacrylates; D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate