A comparative study of the treatment of GOV type gastric varices with large-volume band ligators and tissue glue combined with lauromacrogol injection

doi:10.11958/20231728

Abstract

Abstract:

Objective To compare the efficacy and safety of large volume ligation device and tissue glue injection in the treatment of GOV gastric varicose veins, and to provide reference for the treatment of GOV gastric varicose veins. Methods A total of 150 patients with GOV type gastric varicose veins were prospectively included. Patients were divided into the endoscopic varicose vein ligation (EBL) group (78 cases) and the endoscopic varicose vein embolization (EVO) group (72 cases) according to their condition and willingness. In EBL group, GOV type gastric varices were treated by endoscopic ligation with a large volume ligation device. The EVO group was treated with tissue glue combined with cinnamyl alcohol injection. All patients were re-examined with gastroscopy 2-3 weeks after the first operation to observe whether varicose veins were residual and bleeding (if so, treatment should be repeated at this follow-up visit). Gastroscopy was performed at 1, 3 and 6 months after surgery to evaluate the main outcome measures after endoscopic treatment, including success rate of varicose vein hemostasis, technical success rate, eradication rate, recurrence rate and related complications (secondary indicators): endoscopy-related bleeding, fever, sepsis and distant embolization. Results There were no significant differences in technical success rate, hemostasis success rate, average treatment times and 6-month eradication rate of gastric varices between the EBL group and the EVO group. The recurrence rate was higher in the EVO group than that of EBL group (P<0.05). The endoscopy-related bleeding rate and fever rate were lower in the EBL group than those in the EVO group (P<0.05). In the EVO group, 1 patient developed pulmonary embolism after injection and 3 patients developed septicemia. Conclusion The short-term efficacy of high volume ligation device is similar to that of endoscopic injection of tissue glue in eradicating GOV gastric varices, but the former is safer than the latter.

Key words: esophageal and gastric varices, hemorrhage, cuff ligating therapy, endoscopy, tissue adhesives

CLC Number:

R573.9

Figures/Tables 7

References 31

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组别		n		男/女		年龄/岁			病因（A/B/C/D）^▲				腹水
EBL组		78		52/26		57.40±10.34			55/10/10/3				48（61.5）
EVO组		72		55/17		57.29±10.32			54/12/4/2				37（51.4）
χ²或t				1.731		0.063			2.727				1.571
组别	门脉高压性胃病				门静脉直径/mm			Child-Pugh 分级（A/B/C）			GOV类型（GOV1/GOV2）
EBL组	38（48.7）				14.32±2.27			16/44/18			45/33
EVO组	30（41.7）				14.65±2.92			13/47/12			51/21
χ²或t	0.751				0.781			1.371			2.806
组别			GV分级（F1/F2/F3）				治疗前出血			胃肾分流		胃底静脉曲张直径/mm
EBL组			9/40/29				26（33.3）			32（41.0）		15.09±2.65
EVO组			4/41/27				15（20.8）			28（38.9）		15.25±2.22
χ²或t			1.770				2.945			0.071		0.399

组别		n		男/女		年龄/岁			病因（A/B/C/D）^▲				腹水
EBL组		78		52/26		57.40±10.34			55/10/10/3				48（61.5）
EVO组		72		55/17		57.29±10.32			54/12/4/2				37（51.4）
χ²或t				1.731		0.063			2.727				1.571
组别	门脉高压性胃病				门静脉直径/mm			Child-Pugh 分级（A/B/C）			GOV类型（GOV1/GOV2）
EBL组	38（48.7）				14.32±2.27			16/44/18			45/33
EVO组	30（41.7）				14.65±2.92			13/47/12			51/21
χ²或t	0.751				0.781			1.371			2.806
组别			GV分级（F1/F2/F3）				治疗前出血			胃肾分流		胃底静脉曲张直径/mm
EBL组			9/40/29				26（33.3）			32（41.0）		15.09±2.65
EVO组			4/41/27				15（20.8）			28（38.9）		15.25±2.22
χ²或t			1.770				2.945			0.071		0.399

组别	n	内镜治疗相关出血	发热	败血症	远处栓塞
EBL组	78	2（2.56）	13（16.67）	0	0
EVO组	72	8（11.11）	22（30.56）	3（4.16）	1（1.39）
χ²或P		0.049^▲	4.037^＊	0.108^▲	0.480^▲

组别	n	内镜治疗相关出血	发热	败血症	远处栓塞
EBL组	78	2（2.56）	13（16.67）	0	0
EVO组	72	8（11.11）	22（30.56）	3（4.16）	1（1.39）
χ²或P		0.049^▲	4.037^＊	0.108^▲	0.480^▲