BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized p...BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.展开更多
A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis.The model incorporated six readily av...A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis.The model incorporated six readily available clinical variables—albumin level,aspartate aminotransferase level,white blood cell count,ascites,portal vein thrombosis,and bleeding signs—and demonstrated promising predictive performance.However,limitations,including the retrospective design and exclusion of patients with hepatocellular carcinoma,may affect the generaliz-ability of the model.Additionally,further improvement is needed in the model’s discrimination between intermediate-and high-risk groups in external.Prospec-tive validation and inclusion of additional variables are recommended to enhan-ce predictive accuracy across diverse clinical scenarios.展开更多
BACKGROUND Hepatitis C virus(HCV)infection remains a major public health issue in Egypt,with a high prevalence of genotype 4.Direct-acting antivirals(DAAs)achieve>95%sustained virologic response(SVR),but their impa...BACKGROUND Hepatitis C virus(HCV)infection remains a major public health issue in Egypt,with a high prevalence of genotype 4.Direct-acting antivirals(DAAs)achieve>95%sustained virologic response(SVR),but their impact on variceal rebleeding in genotype 4 cirrhotic patients is underexplored.This study evaluated the association between DAA therapy and variceal rebleeding in Egyptian patients with HCV-related cirrhosis.AIM To evaluate the association between DAA therapy and variceal rebleeding in Egyptian patients with HCV-related cirrhosis.METHODS A multicenter retrospective cohort study included HCV genotype 4 cirrhotic patients from five Egyptian centers with a first variceal bleeding episode.Patients were divided into DAA-treated(Group A)and non-treated(Group B)groups and followed for 5 years.Propensity score matching(PSM),Cox regression,and competing risk analysis were adjusted for confounders.RESULTS DAA treatment significantly reduced variceal rebleeding(HR 2.57;95%CI:1.39-4.72;P=0.002),ascites development over 5 years(6.8%vs 27.1%,P=0.006),and hepatic dysfunction progression.During treatment,it improved liver function[lower model for end-stage liver disease(MELD),stable Child-Pugh class]and reduced complications.All Group A patients achieved SVR by PCR,while Group B remained HCV-positive,likely contributing to the observed reductions in rebleeding and hepatic decompensation.These benefits persisted over 5 years,with longer survival without rebleeding(4.5 years vs 3.2 years),lower MELD(7 vs 12,P<0.001),and reduced hepatic decompensation(Child-Pugh progression:5.1%vs 35.6%,P<0.001).At 5 years,the DAA group had better liver function(higher albumin,lower international normalized ratio,improved platelets),while the non-DAA group worsened.PSM confirmed these findings(HR:0.45,95%CI:0.27-0.75,P=0.002),and competing risk analysis showed sustained protection(sub-distribution HR:0.44,95%CI:0.26-0.74,P=0.002).Endoscopy revealed variceal regression with DAA but progression in the non-DAA group.DAA therapy significantly reduced variceal rebleeding,hepatic decompensation,and mortality(8.5%vs 20.3%,P=0.045),with survival benefits linked to SVR.Additionally,it was associated with improved survival,with a lower 5-year mortality rate in the DAA group(8.5%vs 20.3%,P=0.045).The protective effect of DAA therapy remained consistent across multivariable Cox regression,time-dependent modeling,and competing risk analyses.CONCLUSION DAA treatment in HCV-related cirrhosis significantly reduces variceal rebleeding,ascites development,and hepatic dysfunction progression.The 5-year follow-up data demonstrate sustained improvements in liver function and hematologic parameters,underscoring the long-term benefits of DAA therapy.展开更多
AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or cli...AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.展开更多
AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or...AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.RESULTS: The incidence of early rebleeding after EVL was 7.60%,and the morbidity of rebleeding was 26.9%.Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83,95% CI: 9.39-420.56,P < 0.001],the number of bands placed (OR 17.36,95% CI: 4.00-75.34,P < 0.001),the extent of varices (OR 15.41,95% CI: 2.84-83.52,P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35,95% CI: 1.93-66.70,P = 0.007).CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites,number of rubber bands used to ligate,severity of varices and prolonged PT.Effective measures for prevention and treatment should be adopted before and after EVL.展开更多
AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective databas...AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.展开更多
AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL...AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL procedures performed for EVH between January 2007 and December 2008,128 patients with early rebleeding,defined as rebleeding within 6 wk after EVL,were enrolled for analysis.RESULT:The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817).The 5-d,6-wk,3-mo,and 6-mo mortality rates were 7.8%,38.3%,55.5%,and 58.6%,respectively,in these early rebleeding patients.The use of beta-blockers,occurrence of hypovolemic shock,and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality.A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001).The sensitivity,specificity,positive predictive value,and negative predictive value were 77.6%,81%,71.7%,and 85.3%,respectively.As for the 6-mo survival rate,patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).CONCLUSION:This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.展开更多
AIM: To systematically assess the efficacy and safety of β-adrenergic blocker plus 5-isosorbide mononitrate (BB + ISMN) and endoscopic band ligation (EBL) on prophylaxis of esophageal variceal rebleeding. METHODS: Ra...AIM: To systematically assess the efficacy and safety of β-adrenergic blocker plus 5-isosorbide mononitrate (BB + ISMN) and endoscopic band ligation (EBL) on prophylaxis of esophageal variceal rebleeding. METHODS: Randomized controlled trials (RCTs) comparing the efficacy and safety of BB + ISMN and EBL on prophylaxis of esophageal variceal rebleeding were gathered from Medline, Embase, Cochrane Controlled Trial Registry and China Biological Medicine database between January 1980 and August 2007. Data from five trials were extracted and pooled. The analyses of the available data using the Revman 4.2 software were based on the intention-to-treat principle. RESULTS: Four RCTs met the inclusion criteria. In comparison with BB + ISMN with EBL in prophylaxis of esophageal variceal rebleeding, there was no significant difference in the rate of rebleeding [relative risk (RR), 0.79; 95% CI: 0.62-1.00; P = 0.05], bleeding-related mortality (RR, 0.76; 95% CI: 0.31-1.42; P = 0.40), overall mortality (RR, 0.81; 95% CI: 0.61-1.08; P = 0.15) and complications (RR, 1.26; 95% CI: 0.93-1.70; P = 0.13). CONCLUSION:In the prevention of esophageal variceal rebleeding, BB + ISMN are as effective as EBL. There are few complications with the two treatment modalities. Both BB + ISMN and EBL would be considered as the first-line therapy in the prevention of esophageal variceal rebleeding.展开更多
BACKGROUND Hypertensive cerebral hemorrhage(HICH)is the rupture and bleeding of vessels of the cerebral parenchyma caused by continuously elevated or violently fluctuating blood pressure.The condition is characterized...BACKGROUND Hypertensive cerebral hemorrhage(HICH)is the rupture and bleeding of vessels of the cerebral parenchyma caused by continuously elevated or violently fluctuating blood pressure.The condition is characterized by high disability and high mortality.Hematoma formation and resulting space-occupying effects following intracerebral hemorrhage are among the key causes of impaired neurological function and disability.Consequently,minimally invasive clearance of the hematoma is undertaken for the treatment of HICH because it can effectively relieve intracranial hypertension.Therefore,special attention should be given to the quality of medical and nursing interventions in the convalescent period after minimally invasive hematoma clearance.AIM The study aim was to determine the value of intensive intervention,including doctors,nurses,and patient families,for the prevention of rebleeding in elderly patients with HICH during the first hospitalization for rehabilitation after the ictal event METHODS A total of 150 elderly HICH patients with minimally invasive hematoma evacuation in our hospital between May 2018 and May 2020 were selected and equally divided into two groups of 75 each by their planned intervention.The control group was given conventional nursing intervention and the observation group was given tripartite intensive intervention.The length of hospital stay,cost,complication rate,satisfaction rate,and rebleeding rate during hospitalization were recorded.Changes in cerebral blood flow indicators were recorded in both groups.Changes in the National Institutes of Health Stroke Scale(NIHSS)score,quality of life index(QLI)score,and health behavior score were evaluated at the National Institutes of Health.RESULTS Duration of hospitalization was shorter in the in the observation group than in the control group,the hospitalization cost was less than in the control group,and the rate of rebleeding during hospitalization was lower than in the control group(all P<0.05).There were no significant differences between the two groups before treatment(all P>0.05).The mean flow rate(Qmean)and mean velocity(Vmean)of the two groups increased(P<0.05),and the dynamic resistance and peripheral resistance decreased(P<0.05).The Qmean and Vmean in the intervention group were higher than those in the control group(P<0.05).Moreover,the dynamic resistance and peripheral resistance of the blood vessels were also lower in the intervention group than in the control group(P<0.05).The difference in health behavior scores between the two groups before treatment was not significant(P>0.05).In both groups,the scores for healthy behaviors such as emotion control,medication adherence,dietary management,exercise management,and selfmonitoring were higher after than before treatment(P<0.05),and the scores of healthy behaviors in the intervention group were higher than those in the control group(P<0.05).There was no significant difference in the NIHSS and QLI scores between the two groups before treatment(P>0.05).The QLI scores of the two groups increased(P<0.05),and the NIHSS scores decreased(P<0.05).The QLI scores of the intervention group were higher than those of the control group(P<0.05),and the NIHSS score was correspondingly lower than that of the control group(P<0.05).The incidence of respiratory infections,pressure sores,central hyperpyrexia,and deep venous thrombosis was lower in the intervention group than in the control group.Accordingly,the satisfaction rate was higher in the treatment group than that in the control group(P<0.05).CONCLUSION Intensive intervention by doctors,nurses,and families of elderly patients with HICH reduced the rate of rebleeding during hospitalization.It also reduced the incidence of complications,promoted rehabilitation,improved the quality of life,and enhanced nerve function.Additionally,it improved satisfaction and promoted healthy behaviors.展开更多
There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the r...There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the relationship between satellite sign on computed tomography(CT)scans and postoperative rebleeding after MIS.This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS.We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission.Postoperative rebleeding occurred in 14 of 65(21.5%)patients with the satellite sign on baseline CT,and in 5 of the 40(12.5%)patients without the satellite sign.This diiTerence was statistically significant.Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5%and 87.5%,respectively.Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding.In conclusion,the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.展开更多
AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. METHODST...AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. METHODSThis is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of RESULTSA total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value P value P value P value P value P value P value CONCLUSIONThe 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.展开更多
BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial ...BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial embolization(PTAE)added to successful hemostatic treatment among NVUGIB patients.METHODS We searched three databases from inception through October 19th,2020.Randomized controlled trials(RCTs)and observational cohort studies were eligible.Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE.Investigated outcomes were rebleeding,mortality,reintervention,need for surgery and transfusion,length of hospital(LOH),and intensive care unit(ICU)stay.In the quantitative synthesis,odds ratios(ORs)and weighted mean differences(WMDs)were calculated with the random-effects model and interpreted with 95%confidence intervals(CIs).RESULTS We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients,with 486 in the intervention group.PTAE was associated with lower odds of rebleeding(OR=0.48,95%CI:0.29–0.78).There was no difference in the 30-d mortality rates(OR=0.82,95%CI:0.39–1.72)between the PTAE and control groups.Patients who underwent PTAE treatment had a lower chance for reintervention(OR=0.48,95%CI:0.31–0.76)or rescue surgery(OR=0.35,95%CI:0.14–0.92).The LOH and ICU stay was shorter in the PTAE group,but the difference was non-significant[WMD=-3.77,95%CI:(-8.00)–0.45;WMD=-1.33,95%CI:(-2.84)–0.18,respectively].CONCLUSION PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB.However,further RCTs are needed to have a higher level of evidence.展开更多
BACKGROUND Nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use...BACKGROUND Nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high. AIM To identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management. METHODS We performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient’s records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death;we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with NVUDB.RESULTS We included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%;surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases;the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better outcomes. Our results showed that the Rockall score was associated with both rebleeding and death;comorbidities such as respiratory conditions, liver cirrhosis and sepsis increased significantly the risk of in-hospital mortality (OR of 3.29, 2.91 and 8.03). CONCLUSION Our study revealed that the Rockall score, need for endoscopic therapy, necessity of transfusion and sepsis were risk factors for rebleeding. Moreover, an increased Rockall score and the presence of comorbidities were predictive factors for inhospital mortality.展开更多
AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients...AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years;previously received surgical treatment or endoscopic therapy for variceal bleeding;and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS(TIPS group) while 62 patients received endoscopic therapy(ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rateand cost of treatment were compared between the two groups.RESULTS:During the follow-up period(median,20.7 and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group(Kaplan-Meier analysis and log-rank test,P = 0.000).Rebleeding rates at any time point(6 wk,1 year and 2 year) in the TIPS group were lower than in the ET group(Bonferroni correction α' = α/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test c2 = 4.864,P = 0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates(Bonferroni correction α' = α/3).However,significant differences were observed between the two groups in the 1-year survival rates(92% and 79%) and the 2-year survival rates(89% and 64.9%)(Bonferroni correction α' = α/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy(12 patients in TIPS group and 5 in ET group,KaplanMeier analysis and log-rank test,c2 = 3.103,P = 0.08).The average total cost for the TIPS group was higher than for ET group(Wilcxon-Mann Whitney test,52 678 RMB vs 38 844 RMB,P < 0.05),but hospitalization frequency and hospital stay during follow-up period were lower(Wilcxon-Mann Whitney test,0.4 d vs 1.3 d,P = 0.01;5 d vs 19 d,P < 0.05).CONCLUSION:Early use of TIPS is more effective than endoscopic treatment in preventing variceal rebleeding and improving survival rate,and does not increase occurrence of hepatic encephalopathy.展开更多
基金Supported by National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.
文摘A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis.The model incorporated six readily available clinical variables—albumin level,aspartate aminotransferase level,white blood cell count,ascites,portal vein thrombosis,and bleeding signs—and demonstrated promising predictive performance.However,limitations,including the retrospective design and exclusion of patients with hepatocellular carcinoma,may affect the generaliz-ability of the model.Additionally,further improvement is needed in the model’s discrimination between intermediate-and high-risk groups in external.Prospec-tive validation and inclusion of additional variables are recommended to enhan-ce predictive accuracy across diverse clinical scenarios.
文摘BACKGROUND Hepatitis C virus(HCV)infection remains a major public health issue in Egypt,with a high prevalence of genotype 4.Direct-acting antivirals(DAAs)achieve>95%sustained virologic response(SVR),but their impact on variceal rebleeding in genotype 4 cirrhotic patients is underexplored.This study evaluated the association between DAA therapy and variceal rebleeding in Egyptian patients with HCV-related cirrhosis.AIM To evaluate the association between DAA therapy and variceal rebleeding in Egyptian patients with HCV-related cirrhosis.METHODS A multicenter retrospective cohort study included HCV genotype 4 cirrhotic patients from five Egyptian centers with a first variceal bleeding episode.Patients were divided into DAA-treated(Group A)and non-treated(Group B)groups and followed for 5 years.Propensity score matching(PSM),Cox regression,and competing risk analysis were adjusted for confounders.RESULTS DAA treatment significantly reduced variceal rebleeding(HR 2.57;95%CI:1.39-4.72;P=0.002),ascites development over 5 years(6.8%vs 27.1%,P=0.006),and hepatic dysfunction progression.During treatment,it improved liver function[lower model for end-stage liver disease(MELD),stable Child-Pugh class]and reduced complications.All Group A patients achieved SVR by PCR,while Group B remained HCV-positive,likely contributing to the observed reductions in rebleeding and hepatic decompensation.These benefits persisted over 5 years,with longer survival without rebleeding(4.5 years vs 3.2 years),lower MELD(7 vs 12,P<0.001),and reduced hepatic decompensation(Child-Pugh progression:5.1%vs 35.6%,P<0.001).At 5 years,the DAA group had better liver function(higher albumin,lower international normalized ratio,improved platelets),while the non-DAA group worsened.PSM confirmed these findings(HR:0.45,95%CI:0.27-0.75,P=0.002),and competing risk analysis showed sustained protection(sub-distribution HR:0.44,95%CI:0.26-0.74,P=0.002).Endoscopy revealed variceal regression with DAA but progression in the non-DAA group.DAA therapy significantly reduced variceal rebleeding,hepatic decompensation,and mortality(8.5%vs 20.3%,P=0.045),with survival benefits linked to SVR.Additionally,it was associated with improved survival,with a lower 5-year mortality rate in the DAA group(8.5%vs 20.3%,P=0.045).The protective effect of DAA therapy remained consistent across multivariable Cox regression,time-dependent modeling,and competing risk analyses.CONCLUSION DAA treatment in HCV-related cirrhosis significantly reduces variceal rebleeding,ascites development,and hepatic dysfunction progression.The 5-year follow-up data demonstrate sustained improvements in liver function and hematologic parameters,underscoring the long-term benefits of DAA therapy.
基金Supported by No Financial Interests or Grants support that might have an impact on the views expressed in this study
文摘AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.
文摘AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.RESULTS: The incidence of early rebleeding after EVL was 7.60%,and the morbidity of rebleeding was 26.9%.Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83,95% CI: 9.39-420.56,P < 0.001],the number of bands placed (OR 17.36,95% CI: 4.00-75.34,P < 0.001),the extent of varices (OR 15.41,95% CI: 2.84-83.52,P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35,95% CI: 1.93-66.70,P = 0.007).CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites,number of rubber bands used to ligate,severity of varices and prolonged PT.Effective measures for prevention and treatment should be adopted before and after EVL.
基金Supported by A grant of the Korea Healthcare technology R&D Project,Ministry for Health,Welfare&Family Affairs,Republic of Korea NO.A091047 Medical Research Institute Grant (2009-1),Pusan National University
文摘AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.
文摘AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL procedures performed for EVH between January 2007 and December 2008,128 patients with early rebleeding,defined as rebleeding within 6 wk after EVL,were enrolled for analysis.RESULT:The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817).The 5-d,6-wk,3-mo,and 6-mo mortality rates were 7.8%,38.3%,55.5%,and 58.6%,respectively,in these early rebleeding patients.The use of beta-blockers,occurrence of hypovolemic shock,and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality.A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001).The sensitivity,specificity,positive predictive value,and negative predictive value were 77.6%,81%,71.7%,and 85.3%,respectively.As for the 6-mo survival rate,patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).CONCLUSION:This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.
文摘AIM: To systematically assess the efficacy and safety of β-adrenergic blocker plus 5-isosorbide mononitrate (BB + ISMN) and endoscopic band ligation (EBL) on prophylaxis of esophageal variceal rebleeding. METHODS: Randomized controlled trials (RCTs) comparing the efficacy and safety of BB + ISMN and EBL on prophylaxis of esophageal variceal rebleeding were gathered from Medline, Embase, Cochrane Controlled Trial Registry and China Biological Medicine database between January 1980 and August 2007. Data from five trials were extracted and pooled. The analyses of the available data using the Revman 4.2 software were based on the intention-to-treat principle. RESULTS: Four RCTs met the inclusion criteria. In comparison with BB + ISMN with EBL in prophylaxis of esophageal variceal rebleeding, there was no significant difference in the rate of rebleeding [relative risk (RR), 0.79; 95% CI: 0.62-1.00; P = 0.05], bleeding-related mortality (RR, 0.76; 95% CI: 0.31-1.42; P = 0.40), overall mortality (RR, 0.81; 95% CI: 0.61-1.08; P = 0.15) and complications (RR, 1.26; 95% CI: 0.93-1.70; P = 0.13). CONCLUSION:In the prevention of esophageal variceal rebleeding, BB + ISMN are as effective as EBL. There are few complications with the two treatment modalities. Both BB + ISMN and EBL would be considered as the first-line therapy in the prevention of esophageal variceal rebleeding.
文摘BACKGROUND Hypertensive cerebral hemorrhage(HICH)is the rupture and bleeding of vessels of the cerebral parenchyma caused by continuously elevated or violently fluctuating blood pressure.The condition is characterized by high disability and high mortality.Hematoma formation and resulting space-occupying effects following intracerebral hemorrhage are among the key causes of impaired neurological function and disability.Consequently,minimally invasive clearance of the hematoma is undertaken for the treatment of HICH because it can effectively relieve intracranial hypertension.Therefore,special attention should be given to the quality of medical and nursing interventions in the convalescent period after minimally invasive hematoma clearance.AIM The study aim was to determine the value of intensive intervention,including doctors,nurses,and patient families,for the prevention of rebleeding in elderly patients with HICH during the first hospitalization for rehabilitation after the ictal event METHODS A total of 150 elderly HICH patients with minimally invasive hematoma evacuation in our hospital between May 2018 and May 2020 were selected and equally divided into two groups of 75 each by their planned intervention.The control group was given conventional nursing intervention and the observation group was given tripartite intensive intervention.The length of hospital stay,cost,complication rate,satisfaction rate,and rebleeding rate during hospitalization were recorded.Changes in cerebral blood flow indicators were recorded in both groups.Changes in the National Institutes of Health Stroke Scale(NIHSS)score,quality of life index(QLI)score,and health behavior score were evaluated at the National Institutes of Health.RESULTS Duration of hospitalization was shorter in the in the observation group than in the control group,the hospitalization cost was less than in the control group,and the rate of rebleeding during hospitalization was lower than in the control group(all P<0.05).There were no significant differences between the two groups before treatment(all P>0.05).The mean flow rate(Qmean)and mean velocity(Vmean)of the two groups increased(P<0.05),and the dynamic resistance and peripheral resistance decreased(P<0.05).The Qmean and Vmean in the intervention group were higher than those in the control group(P<0.05).Moreover,the dynamic resistance and peripheral resistance of the blood vessels were also lower in the intervention group than in the control group(P<0.05).The difference in health behavior scores between the two groups before treatment was not significant(P>0.05).In both groups,the scores for healthy behaviors such as emotion control,medication adherence,dietary management,exercise management,and selfmonitoring were higher after than before treatment(P<0.05),and the scores of healthy behaviors in the intervention group were higher than those in the control group(P<0.05).There was no significant difference in the NIHSS and QLI scores between the two groups before treatment(P>0.05).The QLI scores of the two groups increased(P<0.05),and the NIHSS scores decreased(P<0.05).The QLI scores of the intervention group were higher than those of the control group(P<0.05),and the NIHSS score was correspondingly lower than that of the control group(P<0.05).The incidence of respiratory infections,pressure sores,central hyperpyrexia,and deep venous thrombosis was lower in the intervention group than in the control group.Accordingly,the satisfaction rate was higher in the treatment group than that in the control group(P<0.05).CONCLUSION Intensive intervention by doctors,nurses,and families of elderly patients with HICH reduced the rate of rebleeding during hospitalization.It also reduced the incidence of complications,promoted rehabilitation,improved the quality of life,and enhanced nerve function.Additionally,it improved satisfaction and promoted healthy behaviors.
文摘There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the relationship between satellite sign on computed tomography(CT)scans and postoperative rebleeding after MIS.This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS.We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission.Postoperative rebleeding occurred in 14 of 65(21.5%)patients with the satellite sign on baseline CT,and in 5 of the 40(12.5%)patients without the satellite sign.This diiTerence was statistically significant.Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5%and 87.5%,respectively.Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding.In conclusion,the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.
文摘AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. METHODSThis is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of RESULTSA total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value P value P value P value P value P value P value CONCLUSIONThe 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.
基金by Economic Development and Innovation Operative Programme Grant,No.GINOP 2.3.2-15-2016-00048 and No.GINOP-2.3.4-15-2020-00010Human Resources Development Operational Programme Grant,No.EFOP-3.6.2-16-2017-00006 and No.EFOP-3.6.1.-16-2016-00004.
文摘BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial embolization(PTAE)added to successful hemostatic treatment among NVUGIB patients.METHODS We searched three databases from inception through October 19th,2020.Randomized controlled trials(RCTs)and observational cohort studies were eligible.Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE.Investigated outcomes were rebleeding,mortality,reintervention,need for surgery and transfusion,length of hospital(LOH),and intensive care unit(ICU)stay.In the quantitative synthesis,odds ratios(ORs)and weighted mean differences(WMDs)were calculated with the random-effects model and interpreted with 95%confidence intervals(CIs).RESULTS We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients,with 486 in the intervention group.PTAE was associated with lower odds of rebleeding(OR=0.48,95%CI:0.29–0.78).There was no difference in the 30-d mortality rates(OR=0.82,95%CI:0.39–1.72)between the PTAE and control groups.Patients who underwent PTAE treatment had a lower chance for reintervention(OR=0.48,95%CI:0.31–0.76)or rescue surgery(OR=0.35,95%CI:0.14–0.92).The LOH and ICU stay was shorter in the PTAE group,but the difference was non-significant[WMD=-3.77,95%CI:(-8.00)–0.45;WMD=-1.33,95%CI:(-2.84)–0.18,respectively].CONCLUSION PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB.However,further RCTs are needed to have a higher level of evidence.
文摘BACKGROUND Nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high. AIM To identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management. METHODS We performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient’s records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death;we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with NVUDB.RESULTS We included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%;surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases;the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better outcomes. Our results showed that the Rockall score was associated with both rebleeding and death;comorbidities such as respiratory conditions, liver cirrhosis and sepsis increased significantly the risk of in-hospital mortality (OR of 3.29, 2.91 and 8.03). CONCLUSION Our study revealed that the Rockall score, need for endoscopic therapy, necessity of transfusion and sepsis were risk factors for rebleeding. Moreover, an increased Rockall score and the presence of comorbidities were predictive factors for inhospital mortality.
文摘AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years;previously received surgical treatment or endoscopic therapy for variceal bleeding;and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS(TIPS group) while 62 patients received endoscopic therapy(ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rateand cost of treatment were compared between the two groups.RESULTS:During the follow-up period(median,20.7 and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group(Kaplan-Meier analysis and log-rank test,P = 0.000).Rebleeding rates at any time point(6 wk,1 year and 2 year) in the TIPS group were lower than in the ET group(Bonferroni correction α' = α/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test c2 = 4.864,P = 0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates(Bonferroni correction α' = α/3).However,significant differences were observed between the two groups in the 1-year survival rates(92% and 79%) and the 2-year survival rates(89% and 64.9%)(Bonferroni correction α' = α/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy(12 patients in TIPS group and 5 in ET group,KaplanMeier analysis and log-rank test,c2 = 3.103,P = 0.08).The average total cost for the TIPS group was higher than for ET group(Wilcxon-Mann Whitney test,52 678 RMB vs 38 844 RMB,P < 0.05),but hospitalization frequency and hospital stay during follow-up period were lower(Wilcxon-Mann Whitney test,0.4 d vs 1.3 d,P = 0.01;5 d vs 19 d,P < 0.05).CONCLUSION:Early use of TIPS is more effective than endoscopic treatment in preventing variceal rebleeding and improving survival rate,and does not increase occurrence of hepatic encephalopathy.
