Efficacy of metal clip assisted endoscopic variceal ligation on gastric varices
Objective To compare the efficacy and safety of metal clip assisted endoscopic variceal ligation(MEVL)versus endoscopic tissue adhesive injection(ETAI)in the treatment of the gastric varices(GV).Methods Eighty-two cirrhotic patients with gastroesophageal variceal bleeding in Henan Provincial People's Hospital from January 2017 to March 2023 were divided into MEVL group(n=44)and ETAI group(n=38),and were compared the etiology,Child-Pugh score,MELD score,ascites,portal vein thrombosis,hepatic encephalopathy,gastroesophageal variceal classification,severity of esophageal varices(EV),diameter of GV and laboratory indexes between two groups.The number of GV metal clips,number of GV ligating bands,amount of GV tissue adhesive agent,number of EV ligating bands,duration of endoscopic treatment,length of hospital stay and success rate of endoscopic treatment were compared between two groups.The adverse events such as fever,chest pain,nausea/vomiting,off-band,ectopic embolism,glue cast extrusion ulceration,rebleeding and death were recorded in two groups.Results There were no significant differences in the etiology,Child-Pugh score,MELD score,ascites,portal vein thrombosis,hepatic encephalopathy,gastroesophageal variceal classification,severity of EV,diameter of GV,hemoglobin,platelet count,international standard ratio,prothrombin time,total bilirubin,albumin and serum creatinine between two groups(P＞0.05).MEVL group used 3(2,4)GV metal clips and 4(3,7)GV ligating bands,and ETAI group used 3.3(2.0,4.5)mL GV tissue adhesive agent.There were no significant differences in the number of EV ligating bands[8(5,12)vs.7(6,10)],the duration of endoscopic treatment[27(21,34)min vs.25(21,45)min],the length of hospital stay[10(7,13)d vs.13(9,15)d]and the success rate of endoscopic treatment(100.0％vs.94.7％)between MEVL group and ETAI group(P＞0.05).In MEVL group,there were 5 cases of rebleeding and 5 cases of death.In ETAI group,there were 22 cases of glue cast extrusion ulcer,17 cases of rebleeding and 3 cases of death.The incidence rates of nausea/vomiting and rebleeding were lower in MEVL group(2.3％,11.4％)than those in ETAI group(15.8％,44.7％)(P=0.045;x2=11.568,P=0.001),and there were no significant differences in the incidence rates of fever and chest pain and mortality between two groups(P＞0.05).Conclusion MEVL has higher success rate for GV,and lower incidences of postoperative nausea/vomiting and rebleeding than ETAI in patients with gastroesophageal varices.
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