Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data

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

Clin Mol Hepatol. 2013 Mar;19(1):36-44. 10.3350/cmh.2013.19.1.36.

Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data

Affiliations

¹Department of Internal Medicine and Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea.
²Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. umsh@korea.ac.kr
³Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea.
⁴Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
⁵Department of Internal Medicine, Ulsan University College of Medicine, Gangneung, Korea.
⁶Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
⁷Department of Internal Medicine, Ulsan University College of Medicine, Seoul, Korea.
⁸Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea.
⁹Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
¹⁰Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
¹¹Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.
¹²Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
¹³Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.
¹⁴Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
¹⁵Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
¹⁶Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea.
¹⁷Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea.
¹⁸Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
¹⁹Department of Internal Medicine, Catholic University of Daegu College of Medicine, Daegu, Korea.
²⁰Department of Internal Medicine, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, Korea.
²¹Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
²²Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea.
²³Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea.
²⁴Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
²⁵Korean Portal Hypertension Study Group, Korea.

KMID: 1493573
DOI: http://doi.org/10.3350/cmh.2013.19.1.36

Abstract

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.

Keyword

Gastric variceal bleeding; Rebleeding; Mortality; Cirrhosis

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Asian Continental Ancestry Group
Endoscopy
Esophageal and Gastric Varices/*diagnosis/mortality/therapy
Female
*Gastrointestinal Hemorrhage
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prognosis
Republic of Korea
Retrospective Studies
Sclerotherapy
Severity of Illness Index
Treatment Outcome
Young Adult

Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data

Abstract

Keyword

MeSH Terms

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