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. 2022 Oct 21;101(42):e31263.
doi: 10.1097/MD.0000000000031263.

Investigation report on endoscopic management of esophagogastric variceal bleeding by Chinese endoscopists

Wenhui Zhang  1   2 , Yanling Wang  2 , Jindong Chu  2 , Yingdi Liu  3 , Enqiang LingHu  3
Affiliations

Investigation report on endoscopic management of esophagogastric variceal bleeding by Chinese endoscopists

Wenhui Zhang et al. Medicine (Baltimore). .

Abstract

Background: Esophagogastric variceal bleeding (EGVB) is a potentially life-threatening complication of portal hypertension. Endoscopic treatment combined with pharmacotherapy remains the mainstay in the management of acute variceal bleeding.

Aim: This article intends to highlight the potential differences in the endoscopic management of EGVB in China.

Methods: A cross-sectional descriptive study was conducted. Endoscopists from 85 hospitals in 62 cities from 26 provinces were contacted by email. The items in questionnaire involved academic experience, screening, esophagogastric varices (EGV) classification, emergency treatment, and primary and secondary prophylaxis of EGVB by endoscopists with different lengths of experience.

Results: A total of 85 questionnaires were collected. There was no statistical difference in the selection of items (P < .05 indicated statistical significance). The majority of endoscopists (95.29%) offered EGV screening for patients with liver cirrhosis. The location, diameter, and risk factor classification was selected by 82.35% of endoscopists. Endoscopy + medication was preferred (42.35%) for the primary prophylaxis of moderate-to-severe EGVs. There was no statistical difference in emergency intervention time for active EGVB (P > .05). The response "patients receive emergency endoscopic intervention within 12 hours" was selected by 61.2% of the endoscopists. The preferred emergency treatment for EGVB was combination treatment (40%). Tissue adhesive embolization was selected for the treatment of gastric variceal bleeding by 74.12% of endoscopists; transjugular intrahepatic portosystemic stent shunt/percutaneous transhepatic variceal embolization were selected as remedial measures by 48.23% to 52.94% of endoscopists. In addition, 67.06% of endoscopists elected to perform secondary prophylaxis and treatment within 1 week after hemostasis. Endoscopy and endoscopy + medication were selected by 44.71% and 49.41% of endoscopists, respectively, for secondary prophylaxis. The choice of laboratory indicators did not differ with length of experience.

Conclusions: There was no statistical difference in the endoscopic management of EGVB among Chinese endoscopists. The selection of diagnosis/treatment schemes was mainly based on guidelines and physician experience.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Medium-to-large esophageal and gastric varices without bleeding.
Figure 2.
Figure 2.
Time-step number of patients receiving emergency endoscopic intervention.
Figure 3.
Figure 3.
Esophageal varices with bleeding.
Figure 4.
Figure 4.
Cardiac varices with bleeding.
Figure 5.
Figure 5.
Rupture and bleeding of gastric fundus varices.
Figure 6.
Figure 6.
Ectopic varices (duodenal varices).
Figure 7.
Figure 7.
Proportion of treatment options selected by endoscopists for the primary and secondary prophylaxis of varices.
Figure 8.
Figure 8.
Requirements of laboratory indexes for EGVs among endoscopists with different lengths of experience (years). ALB = albumin, INR = international normalized ratio, N = neutrophil count, PLT = platelets.
Figure 9.
Figure 9.
Basis of treatment selection by endoscopists.
See this image and copyright information in PMC

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