THE EFFECTIVENESS OF ENDOSCOPIC INTERVENTIONS IN LIVER CIRRHOSIS PATIENTS

Aim. To analyze the survival of liver cirrhosis patients and to assess the effectiveness of endoscopic interventions to prevent bleedings of portal genesis.

 Material and Мethods. The study included 449 liver cirrhotic patients with portal hypertension and bleeding from gastroesophageal varices. All patients were divided into 2 groups. The main group included 239 patients for the period 2010–2015 and the control group – 210 patients for the period 1996–2010.

 Results. There were 33 (27%) patients without recurrent variceal bleeding after endoscopic interventions in the control group and 64 (54.2%) patients in the main group. These values were 32.4% (45) and 109 (61.6%) respectively in case of staged approach including endoscopic hemostasis followed by portosystemic bypass. Long-term recurrence-free period was observed in 40.7% (33) cases of the control group and in 68.1% (64 of 94) cases of the main group after endoscopy. In case of endoscopic interventions followed by portosystemic bypass recurrence was absent in 45.9% (45 of 98 patients) and 71.2% (102 out of 153 patients) in both groups respectively. Conservative therapy alone was effective only in 3 (10.7%) cases to prevent recurrent bleeding that determines its low therapeutic ineffectiveness.

Conclusion. Modern possibilities of endoscopic technologies have significantly improved treatment and prevention of variceal bleeding. Staged application of endoscopy and portosystemic decompression improves 1-year survival from 80% to 88% and 3-year survival from 42% to 64%. 

1. Figueiredo A., Romero-Bermejo F., Perdigoto R., Marcelino P. The end-organ impairment in liver cirrhosis: appointments for critical care. Crit. Care Res. Pract. 2012; 2012: 539412. DOI: 10.1155/2012/539412.

2. Wiegand J., Berg T. The etiology, diagnosis and prevention of liver cirrhosis – part 1 of a series on liver cirrhosis. Dtsch. Arztebl. Int. 2013; 110 (6): 85–91. DOI: 10.3238/arztebl.2013.0085.

3. Scherzinger A.G., Zhigalova S.B., Melkumov A.B., Manuk'yan V.G. Gastric varices in patients with portal hypertension: diagnosis and treatment. Annaly khirurgicheskoy gepatologii. 2010; 15 (3): 84–94. (In Russian)

4. Nazyrov F.G., Devyatov A.V., Babadjanov A.Kh. Comprehensive analysis of the outcomes and competitive prospects of portosystemic bypass in patients with liver cirrhosis. Annaly khirurgicheskoy gepatologii. 2015; 20 (2): 31–40. (In Russian)

5. Stine J.G., Shah P.M., Cornella S.L., Rudnick S.R., Ghabril M.S., Stukenborg G.J., Northup P.G. Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: a meta-analysis. World J. Hepatol. 2015; 7 (27): 2774–2780. DOI: 10.4254/wjh.v7.i27.2774.

6. Garcia-Tsao G., Lim J. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the department of veterans affairs hepatitis C resource center program and the national hepatitis C program. Am. J. Gastroenterol. 2009; 104 (7): 1802–1829. DOI: 10.1038/ajg.2009.191.

7. Souk K., Al-Badri M., Azar S.T. The safety and benefit of statins in liver cirrhosis: a review. Exp. Clin. Endocrinol. Diabetes. 2015; 123 (10): 577–580. DOI: 10.1055/s-0035-1564093.

8. Romcea A.A., Tanţău M., Seicean A., Pascu O. The etiology of upper gastrointestinal bleeding in cirrhotic patients. Clujul. Med. 2013; 86 (1): 21–23. DOI: 10.3748/wjg.v21.i10.3100.

9. Nazyrov F.G., Sokolova A.S., Devjatov A.V., Sayapin S.N. Analysis of the state and prospects of development of transformed probes to stop bleeding from esophageal varices. Khirurgija. Zhurnal im. N.N. Pirogova. 2010; 12: 58–64. (In Russian)

10. Williams M.J., Hayes P. Improving the management of gastrointestinal bleeding in patients with cirrhosis. Expert. Rev. Gastroenterol. Hepatol. 2016; 10 (4): 505–515. DOI: 10.1586/17474124.2016.1122523.

11. Senzolo M., M. Sartori T., Rossetto V., Burra P., Cillo U., Boccagni P., Gasparini D., Miotto D., Simioni P., Tsochatzis E., A. Burroughs K. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int. 2012; 32 (6): 919–927. DOI: 10.1111/j.1478-3231.2012.02785.x.

12. Escorsell A., Pavel O., Cardenas A., Morillas R., Llop E., Villanueva C., Garcia-Pagan J.C., Bosch J. Variceal Bleeding Study Group. Esophageal balloon tamponade vs esophageal stent in controlling acute refractory variceal bleeding: A multi center RCT. Hepatology. 2016; 63 (6): 1957–1967. DOI: 10.1002/hep.28360.

13. Dzidzava II. Otdalennye rezul'taty hirurgicheskoj korrekcii portal'noj gipertenzii i prognosticheskie faktory vyzhivaemosti u bol'nyh cirrozom pecheni [Long-term results of surgical correction of portal hypertension and predictors of survival in patients with liver cirrhosis: avtoref. dis. … doct. of med. sci.]. St-Petersburg, 2019. 48 p. (In Russian)

14. Holster I.L., Tjwa E.T., Moelker A., Wils A., Hansen B.E., Vermeijden J.R., Scholten P., van Hoek B., Nicolai J.J., Kuipers E.J., Pattynama P.M., van Buuren H.R. Covered TIPS vs endoscopic therapy + Β-blocker for prevention of variceal rebleeding. Hepatology. 2016; 63 (2): 581–589. DOI: 10.1002/hep.28318.