Wang Yi, Li Xiuling, Ding Hui, Li Zhenjuan, Li Jiaxin, Quan Runzhao
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引用次数: 0
Abstract
Background: Gastric variceal bleeding is a common and serious complication of liver cirrhosis and carries a high mortality. Endoscopic variceal ligation (EVL) is widely used, but its efficacy for gastric varices is limited by incomplete variceal capture and a high rate of post-ligation rebleeding.
Objectives: To evaluate the effectiveness and safety of metal clip-assisted endoscopic variceal ligation (MEVL) versus traditional ligation (TL) in adults with cirrhotic gastric varices.
Design: Single-center retrospective observational cohort study, reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement.
Methods: Adults with cirrhosis and gastroesophageal (gastroesophageal varices)-type varices undergoing elective ligation for primary or secondary prophylaxis at Henan Provincial People's Hospital between May 2019 and December 2023 were included; emergency endoscopies were excluded. Non-selective beta-blocker co-therapy was standardized. Baseline imbalance was addressed by propensity score matching and inverse probability of treatment weighting (IPTW), pre-specified as the primary balancing method. Multivariable logistic regression, Cox proportional hazards modeling, and post hoc power were computed in SPSS 26 and Python 3.11.
Results: Ninety-nine patients were analyzed (MEVL n = 46; TL n = 53) with comparable baseline characteristics. One-session eradication was achieved in 33 of 46 MEVL patients (71.7%) compared with 26 of 53 TL patients (49.1%), favoring MEVL after IPTW adjustment (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.03-6.27; p = 0.042) and on Cox regression (adjusted hazard ratio 1.53, 95% CI 1.00-2.35; p = 0.049). Early rebleeding between 120 h and 6 weeks occurred in 0 of 46 MEVL patients versus 5 of 53 TL patients (9.4%; p = 0.059; post hoc power 87%); the adjusted OR for any rebleeding favored MEVL (0.24, 95% CI 0.07-0.82; p = 0.023). All-cause mortality (3/46 vs 6/53) and adverse reactions (11/46 vs 14/53) did not differ.
Conclusion: MEVL was associated with higher one-session eradication than TL, with no increase in adverse reactions. A reduction in cumulative rebleeding was suggested by adjusted logistic regression but was not confirmed by time-to-event Cox analysis; this finding should be interpreted as exploratory rather than definitive. Multicenter prospective validation is required.
Clinical trial registration: Since this is a retrospective, non-randomized study, it was not registered as a clinical trial.
背景：胃静脉曲张出血是肝硬化常见且严重的并发症，死亡率高。内镜下静脉曲张结扎术（EVL）被广泛应用，但其治疗胃静脉曲张的效果受到静脉曲张捕获不完全和结扎后再出血率高的限制。目的：评价金属夹辅助内镜下静脉曲张结扎术（MEVL）与传统结扎术（TL）治疗成人肝硬化胃静脉曲张的有效性和安全性。设计：单中心回顾性观察队列研究，根据STROBE（加强流行病学观察性研究报告）声明报道。方法：纳入2019年5月至2023年12月在河南省人民医院择期结扎进行一级或二级预防的肝硬化和胃食管（胃食管静脉曲张）型静脉曲张的成年人；排除急诊内窥镜检查。非选择性阻滞剂联合治疗标准化。基线不平衡是通过倾向评分匹配和治疗加权逆概率（IPTW）来解决的，这是预先指定的主要平衡方法。在SPSS 26和Python 3.11中计算多变量logistic回归、Cox比例风险模型和事后幂。结果：分析了99例具有可比基线特征的患者（MEVL n = 46; TL n = 53）。46例MEVL患者中有33例（71.7%）和53例TL患者中有26例（49.1%）一次根除，IPTW调整后的MEVL更有利(优势比（OR） 2.55, 95%可信区间（CI） 1.03-6.27；p = 0.042)和Cox回归（校正风险比1.53,95% CI 1.00-2.35; p = 0.049）。在120小时至6周期间，46例MEVL患者中有0例发生早期再出血，53例TL患者中有5例发生早期再出血（9.4%;p = 0.059；事后功率87%）；再出血的调整OR有利于MEVL （0.24, 95% CI 0.07-0.82; p = 0.023）。全因死亡率（3/46 vs 6/53）和不良反应（11/46 vs 14/53）无差异。结论：MEVL的单疗程根除率高于TL，但不良反应未增加。经调整的logistic回归分析表明，累积再出血减少，但时间-事件Cox分析未证实；这一发现应该被解释为探索性的，而不是决定性的。需要多中心前瞻性验证。临床试验注册：由于这是一项回顾性、非随机研究，因此未注册为临床试验。
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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