Clinical value of emergency interventional therapy for acute severe variceal upper gastrointestinal bleeding

Abstract

Objective To evaluate the clinical value of emergency interventional therapy for patients with acute severe variceal upper gastrointestinal bleeding （ASVUGIB）. Methods Clinical data of 48 ASVUGIB patients who received direct or remedial interventional therapy were collected retrospectively. They were divided into the direct interventional therapy group （n = 40） and remedial interventional therapy group （n = 8）. For patients with bleeding signs of contrast medium leakage in angiography, percutaneous transhepatic/transsplenic portal venography + variceal embolization + transjugular intrahepatic portosystemic shunt （TIPS） were performed; for patients without clear signs of bleeding, percutaneous transhepatic/transsplenic portal venography+variceal embolization were performed and TIPS was performed according to the pressure of the portal vein during the operation; for patients with portosystemic shunt, balloon-occluded retrograde transvenous obliteration （BRTO） and TIPS were performed. The patients were followed up for 6 months to observe the clinical prognosis. Results The diagnostic rate of vessels with bleeding lesions in the direct interventional therapy group was 78%, the effective rate was 78%; the rebleeding rates within 7 d, 30 d, 3 months and 6 months were 23%, 45%, 45% and 45%, respectively; the mortality rates within 7 d, 30 d, 3 months and 6 months were 15%, 28%, 28% and 28%, respectively. The diagnostic rate of vessels with bleeding lesions by angiography was 75% in the remedial interventional therapy group, the effective rate was 6/8; the rebleeding rates within 7 d, 30 d, 3 months and 6 months were 2/8, 4/8, 4/8 and 4/8, respectively; the mortality rates within 7 d, 30 d, 3 months and 6 months were 1/8, 3/8, 3/8 and 3/8, respectively. The liver functions （transaminase, albumin and bilirubin） and coagulation function of patients after interventional therapy were improved compared with those before treatment （all P < 0.05）. Child-Pugh and MELD scores were decreased compared with those before treatment （both P < 0.05）. Conclusions ASVUGIB is a common severe acute disease in clinical practice. Early diagnosis, intervention and treatment of ASVUGIB can significantly improve the prognosis of patients. Interventional therapy can be used as treatment for ASVUGIB patients who have contraindications or failures in gastroscopic therapy.

Keywords

• |acute severe variceal upper gastrointestinal bleeding|emergency interventional therapy|portal hypertension