Frontiers in Medicine (Apr 2022)
Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study
- Yifei Huang,
- Wenhui Zhang,
- Wenhui Zhang,
- Huiling Xiang,
- Yanna Liu,
- Lili Yuan,
- Liyao Zhang,
- Shengjuan Hu,
- Dongli Xia,
- Jia Li,
- Min Gao,
- Xing Wang,
- Xingsi Qi,
- Lijun Peng,
- Ying Song,
- Xiqiao Zhou,
- Jing Zeng,
- Xiaoyan Tan,
- Mingming Deng,
- Haiming Fang,
- Shenglin Qi,
- Song He,
- Yongfeng He,
- Bin Ye,
- Wei Wu,
- Tong Dang,
- Jiangbo Shao,
- Wei Wei,
- Jianping Hu,
- Xin Yong,
- Chaohui He,
- Jinlun Bao,
- Yuening Zhang,
- Guo Zhang,
- Rui Ji,
- Yang Bo,
- Wei Yan,
- Hongjiang Li,
- Yanling Wang,
- Mengmeng Li,
- Fengmei Wang,
- Jia Lian,
- Chang’en Liu,
- Ping Cao,
- Zhenbei Liu,
- Aimin Liu,
- Lili Zhao,
- Shuang Li,
- Yunhai Wu,
- Ye Gu,
- Yan Wang,
- Yanfei Fang,
- Pan Jiang,
- Bin Wu,
- Chuan Liu,
- Xiaolong Qi
Affiliations
- Yifei Huang
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
- Wenhui Zhang
- Beijing Shijitan Hospital, Beijing, China
- Wenhui Zhang
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Huiling Xiang
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
- Yanna Liu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- Lili Yuan
- Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China
- Liyao Zhang
- Department of Critical Care Medicine, The Sixth People’s Hospital of Shenyang, Shenyang, China
- Shengjuan Hu
- Department of Gastroenterology, Endoscopic Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Dongli Xia
- Department of Gastroenterology, Chongqing Fuling Central Hospital, Chongqing, China
- Jia Li
- 0Department of Gastroenterology and Hepatology, Tianjin Second People’s Hospital, Tianjin, China
- Min Gao
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Xing Wang
- 2Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Xingsi Qi
- 3Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Lijun Peng
- 4Department of Gastroenterology, Linyi People’s Hospital, Linyi, China
- Ying Song
- 5Department of Gastroenterology, Xi’an GaoXin Hospital, Xi’an, China
- Xiqiao Zhou
- 6Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jing Zeng
- 7Department of Emergency, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
- Xiaoyan Tan
- 8Department of Gastroenterology, Maoming People’s Hospital, Maoming, China
- Mingming Deng
- 9Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Haiming Fang
- 0Department of Gastroenterology and Hepatology, The Second Hospital of Anhui Medical University, Hefei, China
- Shenglin Qi
- 1Department of Hepatology, Dalian Sixth People’s Hospital, Dalian, China
- Song He
- 2Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Yongfeng He
- 3Department of Gastroenterology, Endoscopic Center, Ankang Central Hospital, Ankang, China
- Bin Ye
- 4Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
- Wei Wu
- 5Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Tong Dang
- 6Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
- Jiangbo Shao
- 7Department of Liver Disease, The Third People’s Hospital of Zhenjiang, Zhenjiang, China
- Wei Wei
- 8Department of Gastroenterology, Jinhua Hospital, Jinhua, China
- Jianping Hu
- 9Department of Gastroenterology, First People’s Hospital of Yinchuan City, Yinchuan, China
- Xin Yong
- 0Gastroenterology, General Hospital of Western Theater Command, Chengdu, China
- Chaohui He
- 1Department of Gastroenterology and Endoscopy, The Fifth Affiliated Zhuhai Hospital of Zunyi Medical University, Zhuhai, China
- Jinlun Bao
- 2Department of Gastroenterology, Shannan People’s Hospital, Shannan, China
- Yuening Zhang
- 3Center of Hepatology and Gastroenterology, Beijing You’an Hospital, Capital Medical University, Beijing, China
- Guo Zhang
- 4The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Rui Ji
- 5Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
- Yang Bo
- 6Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Wei Yan
- 7Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hongjiang Li
- 8Department of Hepatology, Baoding People’s Hospital, Baoding, China
- Yanling Wang
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Mengmeng Li
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Fengmei Wang
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
- Jia Lian
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
- Chang’en Liu
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
- Ping Cao
- Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China
- Zhenbei Liu
- Department of Gastroenterology, Chongqing Fuling Central Hospital, Chongqing, China
- Aimin Liu
- Department of Gastroenterology, Chongqing Fuling Central Hospital, Chongqing, China
- Lili Zhao
- 0Department of Gastroenterology and Hepatology, Tianjin Second People’s Hospital, Tianjin, China
- Shuang Li
- 0Department of Gastroenterology and Hepatology, Tianjin Second People’s Hospital, Tianjin, China
- Yunhai Wu
- Department of Critical Care Medicine, The Sixth People’s Hospital of Shenyang, Shenyang, China
- Ye Gu
- Department of Critical Care Medicine, The Sixth People’s Hospital of Shenyang, Shenyang, China
- Yan Wang
- Department of Critical Care Medicine, The Sixth People’s Hospital of Shenyang, Shenyang, China
- Yanfei Fang
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Pan Jiang
- 1Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Bin Wu
- 2Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Chuan Liu
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
- Xiaolong Qi
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
- DOI
- https://doi.org/10.3389/fmed.2022.872881
- Journal volume & issue
-
Vol. 9
Abstract
Background and AimsEmergency endoscopy is recommended for patients with acute esophageal variceal bleeding (EVB) and their prognosis has improved markedly over past decades due to the increased specialization of endoscopic practice. The study aimed to compare outcomes following emergency endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) in cirrhotic patients with acute EVB.MethodsCirrhotic patients with acute EVB who underwent emergency endoscopy were retrospectively enrolled from 2013 to 2020 across 34 university hospitals from 30 cities. The primary outcome was the incidence of 5-day rebleeding after emergency endoscopy. Subgroup analysis was stratified by Child-Pugh class and bleeding history. A 1:1 propensity score matching (PSM) analysis was performed.ResultsA total of 1,017 and 382 patients were included in EIS group and EVL group, respectively. The 5-day rebleeding incidence was similar between EIS group and EVL group (4% vs. 5%, P = 0.45). The result remained the same after PSM (P = 1.00). Among Child-Pugh class A, B and C patients, there were no differences in the 5-day rebleeding incidence between the two groups after PSM (P = 0.25, 0.82, and 0.21, respectively). As for the patients with or without bleeding history, the differences between EIS group and EVL group were not significant after PSM (P = 1.00 and 0.26, respectively).ConclusionThe nationwide cohort study indicates that EIS and EVL are both efficient emergency endoscopic treatment strategies for acute EVB. EIS should not be dismissed as an economical and effective emergency endoscopic treatment strategy of acute EVB. ClincialTrials.gov number NCT04307264.
Keywords
- liver cirrhosis
- portal hypertension
- emergency endoscopy
- endoscopic injection sclerotherapy
- endoscopic variceal ligation
