Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data

Abstract

Background/aims: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea.

Methods: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0±11.0 years, mean±SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated.

Results: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001).

Conclusions: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.

Keywords: Cirrhosis; Gastric variceal bleeding; Mortality; Rebleeding.

Figure 1

Type of intravenous vasoactive agents applied to treat the initial acute gastric variceal bleeding (GVB) among the entire cohort.

Figure 2

Type of nonpharmacologic treatment modalities that were applied to control the initial acute GVB. Endoscopic variceal ligation (EVL) and endoscopic variceal obturation (EVO) were the predominantly applied modalities. BRTO, balloon-occluded retrograde transvenous obliteration; EIS, endoscopic injection sclerotherapy; TIPS, transjugular intrahepatic portosystemic shunt; BT, balloon tamponade; No Tx., no treatment.

Figure 3

Comparison of initial hemostasis failure rates according to the initial nonpharmacologic treatment modality applied (EVL, EVO, and BRTO vs. the others). The failure rate was significantly lower for EVL, EVO, and BRTO than for the other modalities, and did not differ among EVL, EVO, and BRTO.

Figure 4

Comparison of mortality rates according to the initial nonpharmacologic treatment modality applied (EVL, EVO, and BRTO vs. the others). The mortality rate was significantly lower for EVL, EVO, and BRTO than for the other modalities, and did not differ significantly between EVL, EVO, and BRTO.