Impact of the Timing of Endoscopic Diagnosis and Treatment on Treatment Effect and the Prognosis of Emergency Patients with Esophageal and Gastric Variceal Bleeding in Liver Cirrhosis
Objective To investigate the impact of the timing of endoscopic diagnosis and treatment on treatment effect and the prognosis of emergency patients with esophageal-gastric varices bleeding(EGVB)in liver cirrhosis.Methods A total of 96 high-risk emergency patients with liver cirrhosis and EGVB who were admitted to the First Affiliated Hospital of Henan University of Chinese Medicine from October 2018 to February 2023 were reviewed.They were divided into group A(35 cases),group B(29 cases)and group C(32 cases)according to the timing of endoscopic diagnosis and treatment.Patients in group A underwent endoscopic diagnosis and treatment within 0-6 hours after admission.Patients in group B underwent endoscopic diagnosis and treatment within 6-12 hours after admission,and those in group C underwent endoscopic diagnosis and treatment within 12-24 hours after admission.Treatment outcomes(the detection rate of bleeding site,success rate of hemostasis,rebleeding rate and mortality rate),blood transfusion volume,length of hospital stay,and hospitalization expenses were compared among the groups.According to survival status,the patients were divided into survival group(86 cases)and death group(10 cases).Clinical data of the two groups were compared,and multivariate logistic regression analysis was performed to identify the prognostic factors of high-risk emergency EGVB in liver cirrhosis.Results The detection rate of bleeding site in group A and B was higher than that in group C(P＜0.05),but there was no difference between group A and group B(P＞0.05).The success rate of hemostasis in group B was higher than that in group A and C(P＜0.05),there was no difference between group A and group C(P＞0.05).There was no difference in blood transfusion volume,hospital stay and hospital cost among the three groups(P＞0.05).Univariate analysis found that there were statistically significant differences in ascites syndrome,blood sodium,ALT and AST between the survival group and the death group(P＜0.05).Multivariate logistic regression analysis found that ascites syndrome and decreased blood sodium were independent risk factors affecting the prognosis of high-risk emergency EGVB in liver cirrhosis(P＜0.05).Conclusion Endoscopic diagnosis and treatment within 6-12 hours after admission can improve the treatment effect of high-risk emergency EGVB in liver cirrhosis,while endoscopic diagnosis and treatment within 0-6 hours after admission requires more clinical evidence.Ascites syndrome and decreased blood sodium are independent risk factors affecting the prognosis of high-risk emergency EGVB in liver cirrhosis.
emergencyhigh-riskliver cirrhosisesophageal-gastric varices bleedingendoscopic diagnosis and treatmenttimingtreatment effectprognosis
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