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KMID : 1103920130190010036
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Korean Journal of Hepatology
2013 Volume.19 No. 1 p.36 ~ p.44
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Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data
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Kim Moon-Young
Um Soon-Ho
Baik Soon-Koo
Seo Yeon-Seok
Park Soo-Young
Lee Jung-Il
Lee Jin-Woo
Cheon Gab-Jin
Sohn Joo-Hyun
Kim Tae-Yeob
Lim Young-Suk
Kim Tae-Hyo
Lee Tae-Hee
Park Sung-Jae
Park Seung-Ha
Kim Jin-Dong
Han Sang-Young
Choi Chang-Soo
Cho Eun-Young
Kim Dong-Joon
Hwang Jae-Seok
Jang Byoung-Kuk
Lee June-Sung
Kim Sang-Gyune
Kim Young-Seok
Kwon So-Young
Choe Won-Hyeok
Lee Chang-Hyeong
Kim Byung-Seok
Jang Jae-Young
Jeong Soung-Won
Kim Byung-Ho
Shim Jae-Jun
Cho Yong-Kyun
Koh Moon-Soo
Lee Hyun-Woong
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Abstract
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Background/Aims: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea.
Methods: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0±11.0 years, mean±SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated.
Results: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001).
Conclusions: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.
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KEYWORD
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Gastric variceal bleeding, Rebleeding, Mortality, Cirrhosis
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