Clin Mol Hepatol.  2019 Jun;25(2):183-189. 10.3350/cmh.2018.0039.

Endoscopic treatment or balloon-occluded retrograde transvenous obliteration is safe for patients with esophageal/gastric varices in Child-Pugh class C end-stage liver cirrhosis

• Yokoyama K
• Yamauchi R
• Shibata K
• Fukuda H
• Kunimoto H
• Takata K
• Tanaka T
• Inomata S
• Morihara D
• Takeyama Y
• Shakado S
• Sakisaka S

• KMID: 2451922
• DOI: http://doi.org/10.3350/cmh.2018.0039

Abstract

BACKGROUND/AIMS
There is a controversy about the availability of invasive treatment for esophageal/gastric varices in patients with Child-Pugh class C (CP-C) end-stage liver cirrhosis (LC). We have evaluated the validity of invasive treatment with CP-C end-stage LC patients.
METHODS
The study enrolled 51 patients with CP-C end-stage LC who had undergone invasive treatment. The treatment modalities included endoscopic variceal ligation in 22 patients, endoscopic injection sclerotherapy in 17 patients, and balloon-occluded retrograde transvenous obliteration (BRTO) in 12 patients. We have investigated the overall survival (OS) rates and risk factors that contributed to death within one year after treatment.
RESULTS
The OS rate in all patients at one, three, and five years was 72.6%, 30.2%, and 15.1%, respectively. The OS rate in patients who received endoscopic treatment and the BRTO group at one, three, and five years was 67.6%, 28.2% and 14.1% and 90.0%, 36.0% and 18.0%, respectively. The average of Child-Pugh scores (CPS) from before treatment to one month after variceal treatment significantly improved from 10.53 to 10.02 (P=0.003). Three significant factors that contributed to death within one year after treatment included the presence of bleeding varices, high CPS (≥11), and high serum total bilirubin levels (≥4.0 mg/dL).
CONCLUSIONS
The study demonstrated that patients with a CPS of up to 10 and less than 4.0 mg/dL of serum total bilirubin levels may not have a negative impact on prognosis after invasive treatment for esophageal/gastric varices despite their CP-C end-stage LC.

Keyword

Portal hypertension; Liver cirrhosis; Esophageal and gastric varices; Endoscopy; Balloon occlusion

MeSH Terms

Balloon Occlusion
Bilirubin
Endoscopy
Esophageal and Gastric Varices
Hemorrhage
Humans
Hypertension, Portal
Ligation
Liver Cirrhosis*
Liver*
Prognosis
Risk Factors
Sclerotherapy
Varicose Veins*
Bilirubin