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Title: |
Experience in the Treatment of Gastroesophageal Variceal Bleeding Caused by Portal Hypertension in Cirrhosis by Restricted Rehydration Combined with Gastroscopy | |||||||||||||||||||
| Authors: | Chengbin Zhang, M.D., Hong Zhao, B.S., Yaqiong Wang, M.D., Juanjuan Li, M.D., Yuemin Chen, B.S., Juan Sun, M.D., Caihong Xu, Xiaoyao Wang, and Shaohui Tang, Ph.D. | |||||||||||||||||||
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Objective: To investigate the hemostatic effect and clinical prognosis of restricted rehydration combined with gastroscopy in the treatment of gastroesophageal varicose bleeding caused by portal hypertension (PHT) in cirrhosis.
Study Design: Forty liver cirrhotic patients with PHT and gastroesophageal variceal bleeding were divided into observation (n=21) and control (n=19) groups. The observation group was treated with early restricted rehydration and drugs, and 72 hours after the bleeding stopped, enhanced computed tomography portal venography was completed, and then the varicose veins were treated by gastroscopy under general anesthesia. The control group was treated with the same drugs and routine fluid replacement, then emergency gastroscope hemostasis was performed within 24–48 hours under waking state. Results: After treatment 24 hours after admission, the observation group received rehydration, blood transfusion, and sodium chloride significantly less than the control group. The 2 groups were significantly different in terms of hematemesis or melena, lactic acid level, and model for end-stage liver disease (MELD) score. There was no difference in blood pressure between groups. Theoperation time of the observation group was significantly less than that of the control group. There were no intraoperative hemorrhage cases, no fever after treatment, no spontaneous peritonitis cases, no hepatic encephalopathy and ectopic embolism cases, and no rebleeding after operation. At 6 months’ follow-up the variceal obliteration rate was 100%, with no rebleeding or death cases, while in the control group bleeding occurred in 14 patients during the operation, among which in 2 patients the bleeding failed to be stopped by gastroscopy. Postoperative rebleeding occurred in 3 patients, spontaneous peritonitis in 3 patients, hepatic encephalopathy in 2 patients, and cerebral infarction in 1 patient. After 6 months of follow-up 15 patients had varicose vein obliterated, and 3 cases had rebleeding. No patients died in either group. Conclusion: Restricted rehydration combined with gastroscopy in the treatment of PHT in cirrhosis with esophagogastric variceal bleeding can improve hemostatic effect, improve clinical prognosis, and reduce the risk of rebleeding. |
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| Keywords: | cirrhosis, gastroesophageal variceal bleeding, gastroscopy, hemostasis, portal hypertension, restricted rehydration | |||||||||||||||||||
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