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. 2021 Dec 20;41(12):1822-1827.
doi: 10.12122/j.issn.1673-4254.2021.12.10.

[Value of purple sign for predicting rebleeding events in cirrhotic patients following endoscopic selective varices devascularization]

[Article in Chinese]
Y Wu  1 , M Chen  1 , M Huang  1 , G Liao  1 , S Tang  1 , H Zheng  1 , Y Li  1 , B Peng  1 , X Zheng  1 , S Pan  1 , J Hou  2 , B Chen  2
Affiliations

[Value of purple sign for predicting rebleeding events in cirrhotic patients following endoscopic selective varices devascularization]

[Article in Chinese]
Y Wu et al. Nan Fang Yi Ke Da Xue Xue Bao. .

Abstract
in English, Chinese

Objective: To assess the value of the purple sign for predicting long-term rebleeding events in cirrhotic patients following endoscopic selective varices devascularization.

Methods: We retrospectively analyzed the clinical data of 97 patients with liver cirrhosis, who had a history of gastroesophageal variceal bleeding and underwent endoscopic selective varices devascularization. Thirty-two of the patients showed purple sign after endoscopic treatment. We used propensity score matching (PSM) to minimize the selection bias of the patients (purple sign vs no purple sign) and reduce the intergroup differences of clinical characteristics. The primary outcome measure of this study was cumulative rebleeding events after endoscopic selective varices devascularization.

Results: The 1-year rebleeding rate (27.0% vs 36.7%) or 6-month rebleeding rate (10.9% vs 26.9%) following endoscopic treatment was not significantly different between the purple sign group and no purple sign group before PSM (P=0.2385). But after PSM, the 1-year rebleeding rate (28.2% vs 56.4%) and 6-month rebleeding rate (5.0% vs 37.0%) were significantly lower in the purple sign group than in the no purple sign group (P=0.0304).

Conclusions: The presence of purple sign indicates a lower risk of rebleeding after endoscopic treatment of cirrhotic gastroesophageal varices and a potentially favorable treatment response after endoscopic therapy, thus providing a clinical indicator for stratification of the patients for sequential endoscopic sessions.

目的: 研究紫色征对肝硬化静脉曲张破裂出血内镜治疗后再出血的预测作用。

方法: 研究对97例肝硬化静脉曲张破裂出血患者行内镜下精准贲门胃静脉曲张断流术（ESVD术）治疗进行回顾性分析，根据内镜治疗过程中是否出现了紫色征进行分组，出现紫色征患者为观察组，共32例，未出现紫色征患者为对照组，共65例；通过倾向性匹配评分的方式平衡观察组（紫色征组）与对照组（非紫色征组）患者临床特征的差异，同时减少研究对象的选择偏倚，研究结局为ESVD术后再出血率。

结果: 匹配前观察组与对照组1年再出血率（27.0% vs 36.7%）与6月再出血率（10.9% vs 26.9%）差异无统计学差异（P=0.2385）；匹配后观察组与对照组1年再出血率（28.2% vs 56.4%）与6月再出血率（5.0% vs 37.0%）差异有统计学意义（P=0.0304）。

结论: 紫色征可作为预测肝硬化患者胃食管静脉曲张破裂出血后低再出血风险的指标，为此类患者内镜序贯治疗管理提供指导意义。

Keywords: endoscopic selective varices devascularization; gastroesophageal varices; propensity score matching; purple sign; rebleeding.

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Figures

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1
内镜治疗后曲张静脉表层出现紫色征（黑色箭头） Purple sign (black arrow) on varices after endoscopic variceal obturation. A-D: Occurrence of the purple sign during endoscopic treatment in a patient. E-G: Occurrence of the purple sign in different patients.
2
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Kaplan-Meier曲线，观察组与对照组再出血率比较 Kaplan-Meier curves for comparison of rebleeding rates between the purple sign group and no purple sign group before (A) and after (B) propensity score matching (PSM). Intention-to-treat analysis was used to compare the rebleeding rates between the two groups before (C) and after (D) PSN. The rebleeding rates were also compared using per-protocol analysis between the two groups before (E) and after (F) PSM.
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