Endoscopic treatment as secondary prophylaxis ameliorates short-term mortality for acute esophagogastric variceal bleeding in older patients with cirrhotic hepatocellular carcinoma.

Abstract

Background: Acute esophagogastric variceal bleeding (AEGVB) is a common complication of liver cirrhosis and hepatocellular carcinoma (HCC). It is unclear if older patients with cirrhotic HCC benefit from endoscopic treatment as secondary prophylaxis for AEGVB in short term.

Objectives: We aim to investigate if endoscopic treatment as secondary prophylaxis for AEGVB reduces short-term mortality in older patients with cirrhotic HCC.

Design: We retrospectively enrolled 138 consecutive patients over 60 years old with cirrhotic HCC and AEGVB from April 1, 2021 through December 31, 2022 in Emergency Room, Beijing You'an Hospital, Capital Medical University.

Methods: A 1:1 propensity score matching (PSM) analysis was performed to adjust for confounding factors such as age, gender, Child-Pugh score in our statistical findings. Logistic regression and Cox regression analyses were used to investigate whether there was a significant negative association between endoscopic treatment and short-term mortality for AEGVB in older patients with cirrhotic HCC. Kaplan-Meier methodology was employed to compare overall survival over 6 weeks between the endoscopic treatment group and non-endoscopic treatment group.

Results: In older patients with cirrhotic HCC and AEGVB, in-hospital mortality and 6-week mortality were significantly lower in the endoscopic treatment group compared to the non-endoscopic treatment group before PSM (5.33% vs 26.98%, p = 0.001 for in-hospital mortality; 12.00% vs 44.44%; p < 0.001 for 6-week mortality). These results remained consistent after PSM (4.76% vs 26.98%, p = 0.002 for in-hospital mortality; 9.52% vs 44.44%; p < 0.001 for 6-week mortality). Both logistic regression and Cox regression analyses found that endoscopic treatment contributed to reduced short-term mortality for AEGVB in older patients with cirrhotic HCC. Kaplan-Meier survival curves indicated that older patients undergoing endoscopic treatment had a higher short-term survival rate than those who didn't receive endoscopic treatment in our cohort. However, there was no significant difference in short-term survival between patients receiving endoscopic variceal ligation and those treated with endoscopic injection sclerotherapy.

Conclusion: Secondary prophylaxis of endoscopic treatment helps to reduce 6-week mortality for AEGVB in older patients with cirrhotic HCC. Therefore, endoscopic treatment is suggested to be employed as secondary prophylaxis in this special population in clinical practice.