Author:
Huang Yifei,Zhang Wenhui,Xiang Huiling,Liu Yanna,Yuan Lili,Zhang Liyao,Hu Shengjuan,Xia Dongli,Li Jia,Gao Min,Wang Xing,Qi Xingsi,Peng Lijun,Song Ying,Zhou Xiqiao,Zeng Jing,Tan Xiaoyan,Deng Mingming,Fang Haiming,Qi Shenglin,He Song,He Yongfeng,Ye Bin,Wu Wei,Dang Tong,Shao Jiangbo,Wei Wei,Hu Jianping,Yong Xin,He Chaohui,Bao Jinlun,Zhang Yuening,Zhang Guo,Ji Rui,Bo Yang,Yan Wei,Li Hongjiang,Wang Yanling,Li Mengmeng,Wang Fengmei,Lian Jia,Liu Chang’en,Cao Ping,Liu Zhenbei,Liu Aimin,Zhao Lili,Li Shuang,Wu Yunhai,Gu Ye,Wang Yan,Fang Yanfei,Jiang Pan,Wu Bin,Liu Chuan,Qi Xiaolong
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.