Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2023; 15(3): 153-162
Published online Mar 16, 2023. doi: 10.4253/wjge.v15.i3.153
Aluminum phosphate gel reduces early rebleeding in cirrhotic patients with gastric variceal bleeding treated with histoacryl injection therapy
Hao-Tian Zeng, Zhu-Liang Zhang, Xi-Min Lin, Min-Si Peng, Li-Sheng Wang, Zheng-Lei Xu
Hao-Tian Zeng, Zhu-Liang Zhang, Xi-Min Lin, Min-Si Peng, Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
Li-Sheng Wang, Zheng-Lei Xu, Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
Author contributions: Xu ZL conceived the idea for the manuscript; Zeng HT and Zhang ZL contributed equally to this study, are considered as co-first authors, and wrote the first draft of the manuscript; Lin XM and Peng MS searched part of the information; Wang LS reviewed and revised the manuscript.
Supported by Clinical Research and Cultivation Project of Shenzhen People's Hospital, No. SYLCYJ202116.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Shenzhen Municipal People's Hospital Institutional Review Board (Approval No. 20150108).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no any conflict-of-interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Lei Xu, MD, Chief Doctor, Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, No. 1017 Dongmen North Road, Shenzhen 518000, Guangdong Province, China. 78249073@qq.com
Received: November 9, 2022
Peer-review started: November 9, 2022
First decision: November 22, 2022
Revised: November 26, 2022
Accepted: March 1, 2023
Article in press: March 1, 2023
Published online: March 16, 2023
Abstract
BACKGROUND

Esophageal-gastro varices bleeding (EGVB) is the most widely known cause of mortality in individuals with cirrhosis, with an occurrence rate of 5% to 15%. Among them, gastric varices bleeding (GVB) is less frequent than esophageal varices bleeding (EVB), but the former is a more critical illness and has a higher mortality rate. At present, endoscopic variceal histoacryl injection therapy (EVHT) is safe and effective, and it has been recommended by relevant guidelines as the primary method for the treatment of GVB. However, gastric varices after endoscopic treatment still have a high rate of early rebleeding, which is mainly related to complications of its treatment, such as bleeding from drained ulcers, rebleeding of varices etc. Therefore, preventing early postoperative rebleeding is very important to improve the quality of patient survival and outcomes.

AIM

To assess the efficacy of aluminium phosphate gel (APG) combined with proton pump inhibitor (PPI) in preventing early rebleeding after EVHT in individuals with GVB.

METHODS

Medical history of 196 individuals with GVB was obtained who were diagnosed using endoscopy and treated with EVHT in Shenzhen People's Hospital from January 2016 to December 2021. Based on the selection criteria, 101 patients were sorted into the PPI alone treatment group, and 95 patients were sorted into the PPI combined with the APG treatment group. The incidences of early rebleeding and corresponding complications within 6 wk after treatment were compared between both groups. Statistical methods were performed by two-sample t-test, Wilcoxon rank sum test and χ2 test.

RESULTS

No major variations were noted between the individuals of the two groups in terms of age, gender, Model for End-Stage Liver Disease score, coagulation function, serum albumin, hemoglobin, type of gastric varices, the dose of tissue glue injection and EV that needed to be treated simultaneously. The early rebleeding rate in PPI + APG group was 3.16% (3/95), which was much lower than that in the PPI group (12.87%, 13/101) (P = 0.013). Causes of early rebleeding: the incidence of gastric ulcer bleeding in the PPI + APG group was 2.11% (2/95), which was reduced in comparison to that in the PPI group (11.88%, 12/101) (P = 0.008); the incidence of venous bleeding in PPI + APG group and PPI group was 1. 05% (1/95) and 0.99% (1/101), respectively, and there was no significant difference between them (0.999). The early mortality rate was 0 in both groups within 6 wk after the operation, and the low mortality rate was related to the timely hospitalization and active treatment of all patients with rebleeding. The overall incidence of complications in the PPI + APG group was 12.63% (12/95), which was not significantly different from 13.86% (14/101) in the PPI group (P = 0.800). of abdominal pain in the PPI + APG group was 3.16% (3/95), which was lower than that in the PPI group (11.88%, 12/101) (P = 0.022). However, due to aluminum phosphate gel usage, the incidence of constipation in the PPI + APG group was 9.47% (9/95), which was higher than that in the PPI group (1.98%, 2/101) (P = 0.023), but the health of the patients could be improved by increasing drinking water or oral lactulose. No patients in either group developed spontaneous peritonitis after taking PPI, and none developed hepatic encephalopathy and ectopic embolism within 6 wk of EVHT treatment.

CONCLUSION

PPI combined with APG can significantly reduce the incidence of early rebleeding and postoperative abdominal pain in cirrhotic patients with GVB after taking EVHT.

Keywords: Gastric varices bleeding, Endoscopic variceal histoacryl injection therapy, Proton pump inhibitor, Aluminium phosphate gel, Early rebleeding

Core Tip: Gastric varices bleeding (GVB) is a serious life-threatening disease, and endoscopic variceal histoacryl injection therapy (EVHT) can effectively maintain hemostasis during the disease. Nevertheless, complications after EVHT, such as bleeding during drainage and ulceration at the injection site, can lead to early rebleeding. Currently, there are few clinical studies on preventing early rebleeding after EVHT in patients with GVB. We have found that using aluminium phosphate gel combined with proton pump inhibitor after EVHT could significantly reduce early rebleeding after endoscopic treatment in individuals with GVB.