Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2021; 13(12): 1651-1659
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1651
Effect of aluminum phosphate gel on prevention of early rebleeding after ligation of esophageal variceal hemorrhage
Zhu-Liang Zhang, Min-Si Peng, Ze-Ming Chen, Ting Long, Li-Sheng Wang, Zheng-Lei Xu
Zhu-Liang Zhang, Min-Si Peng, Ze-Ming Chen, Ting Long, Li-Sheng Wang, Zheng-Lei Xu, The Second Clinical Medical College of Jinan University, Shenzhen 518000, Guangdong Province, China
Zhu-Liang Zhang, Min-Si Peng, Ze-Ming Chen, Li-Sheng Wang, Zheng-Lei Xu, Department of Gastroenterology, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China
Ting Long, Department of Pathology, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
Author contributions: Xu ZL conceived the idea for the study; Zhang ZL, Peng MS, Chen ZM, Long T, and Xu ZL collected the case data and drafted the manuscript; Wang LS reviewed and revised the manuscript.
Supported by Natural Science Foundation of Guangdong Province of China, No. 2018A0303130278.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Shenzhen People’s Hospital.
Informed consent statement: This study has received informed consent from all patients.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: Dataset available from the corresponding author at 78249073@qq.com.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Lei Xu, MD, Associate Professor, Chief Doctor, The Second Clinical Medical College of Jinan University, No. 1017 Dongmen North Road, Shenzhen 518000, Guangdong Province, China. 78249073@qq.com
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: July 14, 2021
Revised: July 14, 2021
Accepted: November 14, 2021
Article in press: November 14, 2021
Published online: December 27, 2021
Processing time: 240 Days and 10.3 Hours
Abstract
BACKGROUND

Liver cirrhosis is the main cause of portal hypertension. The leading cause of death in patients with liver cirrhosis is its most common complication, esophageal variceal bleeding (EVB). Endoscopic variceal ligation (EVL) is recommended by many guidelines to treat EVB and prevent rebleeding; however, esophageal ulcers occur after treatment. Delayed healing of ulcers and unhealed ulcers lead to high rebleeding and mortality rates. Thus, the prevention of early postoperative rebleeding is of great significance in improving the quality of life and prognosis of patients.

AIM

To evaluate the efficacy of aluminum phosphate gel (APG) plus a proton pump inhibitor (PPI) in the prevention of early rebleeding after EVL in patients with EVB.

METHODS

The medical records of 792 patients who were diagnosed with EVB and in whom bleeding was successfully stopped by EVL at Shenzhen People’s Hospital, Guangdong Province, China from January 2015 to December 2020 were collected. According to the study inclusion and exclusion criteria, 401 cases were included in a PPI-monotherapy group (PPI group), and 377 cases were included in a PPI and APG combination therapy (PPI + APG) group. We compared the incidence rates of early rebleeding and other complications within 6 wk after treatment between the two groups. The two-sample t-test, Wilcoxon rank-sum test, and chi-squared test were adopted for statistical analyses.

RESULTS

No significant differences in age, sex, model for end-stage liver disease score, coagulation function, serum albumin level, or hemoglobin level were found between the two groups. The incidence of early rebleeding in the PPI + APG group (9/337; 2.39%) was significantly lower than that in the PPI group (30/401; 7.48%) (P = 0.001). Causes of early rebleeding in the PPI group were esophageal ulcer (3.99%, 16/401) and esophageal varices (3.49%, 14/401), while those in the PPI + APG group were also esophageal ulcers (5/377; 1.33%) and esophageal varices (4/377; 1.06%); such causes were significantly less frequent in the PPI + APG group than in the PPI group (P = 0.022 and 0.024, respectively). The early mortality rate within 6 wk in both groups was 0%, which was correlated with the timely rehospitalization of all patients with rebleeding and the conduct of emergency endoscopic therapy. The incidence of adverse events other than early bleeding in the PPI + APG group (28/377; 7.43%) was significantly lower than that in the PPI group (63/401; 15.71%) (P < 0.001). The incidence of chest pain in the PPI + APG group (9/377; 2.39%) was significantly lower than that in the PPI group (56/401; 13.97%) (P < 0.001). The incidence of constipation in the PPI + APG group (16/377; 4.24%) was significantly higher than that in the PPI group (3/401; 0.75%) (P = 0.002) but constipation was relieved after patients drank more water or took lactulose. In the PPI and PPI + APG groups, the incidence rates of spontaneous peritonitis within 6 wk after discharge were 0.50% (2/401) and 0.53% (2/377), respectively, and those of hepatic encephalopathy were 0.50% (2/401) and 0.27% (1/377), respectively, presenting no significant difference (P > 0.999).

CONCLUSION

PPI + APG combination therapy significantly reduces the incidence of early rebleeding and chest pain in patients with EVB after EVL.

Keywords: Esophageal variceal bleeding; Esophageal variceal ligation; Proton pump inhibitor; Endoscopic variceal ligation; Aluminum phosphate gel

Core Tip: Esophageal variceal bleeding (EVB) is a common disease with a high mortality rate. Esophageal variceal ligation (EVL) is an effective means of hemostasis; however, ulcer foci of the esophagus can form after treatment. Patients with delayed healing of ulcers and unhealed ulcers are prone to experiencing early rebleeding. No studies have reported on the promotion of ulcer healing or prevention of rebleeding in EVB patients after EVL. This study showed that the application of aluminum phosphate gel in combination with a proton pump inhibitor after EVL significantly reduced the incidence of early rebleeding following endoscopic surgery in EVB patients.