Comparison of the management of gastric variceal bleeding techniques

Fariha Ilyas; Hassam Ali; Pratik Patel; Nairuti Shah; Rizwan Ishtiaq; Alexa Giammarino; Sanjaya K Satapathy

doi:10.1002/jgh3.13001

Comparison of the management of gastric variceal bleeding techniques

JGH Open. 2023 Nov 13;7(12):908-915. doi: 10.1002/jgh3.13001. eCollection 2023 Dec.

Authors

Fariha Ilyas¹, Hassam Ali¹, Pratik Patel², Nairuti Shah³, Rizwan Ishtiaq⁴, Alexa Giammarino⁵, Sanjaya K Satapathy⁶

Affiliations

¹ Department of Internal Medicine ECU Health Medical Center Greenville North Carolina USA.
² Department of Gastroenterology Mather Hospital/Zucker School of Medicine at Hofstra University Port Jefferson New York USA.
³ Department of Internal Medicine NYU Langone Hospital Long Island/NYU Long Island School of Medicine Mineola New York USA.
⁴ Department of Internal Medicine University of Connecticut Health Center Farmington Connecticut USA.
⁵ Department of Internal Medicine North Shore University Hospital/Zucker School of Medicine at Hofstra University Manhasset New York USA.
⁶ Department of Hepatology North Shore University Hospital/Zucker School of Medicine at Hofstra University Manhasset New York USA.

Abstract

Background and aim: Managing gastric variceal (GV) hemorrhage is more complicated than managing esophageal variceal (EV) bleeding, resulting in significantly higher morbidity and mortality. We aim to compare the outcomes of endoscopic variceal ligation (EVL), transhepatic intrahepatic portosystemic shunt (TIPS), and balloon-occluded retrograde transvenous obliteration (BRTO) in the management of GV bleeding.

Methods: We utilized the National Inpatient Sample (NIS) database from January 2016 to December 2019 to include adult patients with GV hemorrhage.

Results: Our study identified 7160 hospitalizations with a primary diagnosis of GV hemorrhage who underwent the interventions of interest. EVL was performed in 69.83%, TIPS in 8.72%, and BRTO in 4.88%. Patients with liver cirrhosis had a higher frequency of undergoing BRTO (68.6%), followed by TIPS (64.0%) and esophagogastroduodenoscopy (EGD) + TIPS (63.7%) (P < 0.001). Patients with cirrhosis secondary to alcoholism had a higher prevalence of TIPS (62.4%), followed by EGD + TIPS (69.4%) and BRTO (52.9%) (P < 0.001). Overall, the inpatient mortality was 6.5%. Overall inpatient mortality was highest in the TIPS cohort (8.8%), followed by BRTO (7.1%), EGD + TIPS (6.5%), EVL (6.2%), and EGD + BRTO (2.8%) (P < 0.001); However, the Kaplan-Meier graph showed endoscopy with BRTO had the most favorable 30-day survival, trailed by TIPS alone and BRTO alone.

Conclusion: EVL remains a prominent therapeutic strategy. Remarkably, the combination of endoscopy with BRTO shows promising 30-day survival outcomes. Considering these observations, although EVL holds its primacy, it is essential to further explore the potential benefits of combined therapies in larger studies to ascertain the best treatment strategies.

Keywords: alcoholism; balloon‐occluded retrograde transvenous obliteration; endoscopic variceal ligation; transjugular intrahepatic portosystemic shunt.