IDDF2019-ABS-0037 Rebleeding and prognosis in cirrhotic patients after eradication of esophagogastric varices by endoscopic sequential therapy: a tertiary centre cohort study

Background Esophagogastric variceal bleeding (EGVB) is a severe complication of liver cirrhosis and variceal eradication by modern endoscopic strategies may improve the recurrence and prognosis. Scant data is available about long-term observation after EGV eradication. We reported the incidence of rebleeding, variceal recurrence and mortality by endoscopic sequential therapy (EST), and investigated risk factors associated with prognosis. Methods We carried out a retrospective cohort study recruiting consecutive cirrhotic patients with EGV who were regularly followed up in our endoscopy centre from Oct 2011 to June 2018. EST was defined as a combination strategy of band ligation, histoacryl injection and sclerotherapy. All patients had undergone EST until complete variceal eradication. Relevant medical and endoscopic data were collected. Rebleeding, variceal recurrence and all-cause mortality were considered as major outcomes. We calculated cumulative incidences of the outcomes and used Cox proportional hazard model to estimate hazard ratio (HR) and to identify risk factors. Results We identified 468 patients for screening and 291 of them were finally included for analysis. The mean follows up duration was 32.4 months. After eradication of EGV, rebleeding was identified in 29 patients, and the cumulative incidence of rebleeding at 1 year, 2 year and 5 year was 3.4%, 6.5% and 9.6% respectively. Variceal recurrence was observed in 49 patients while the cumulative incidence at 1 year, 2 year and 5 year was 5.5%, 11.6% and 15.5% respectively. Ten patients died and the cumulative mortality at 1 year, 2 year and 5 year was 0.3%, 1.7% and 3.4% respectively. Patients of viral and alcoholic mixed etiology and patients with higher baseline MELD score (≥20) had a higher rebleeding risk (HR, 6.69 and 5.75, respectively), and patients underwent more sessions of endoscopic treatment had lower variceal recurrence risk (HR 0.81). Baseline presence of portal vein thrombosis and MELD score was highly associated with mortality (HR 8.1 and 8.4 respectively). Conclusions Recurrent bleeding and mortality have been greatly improved after variceal eradication through EST in cirrhotic patients with EGV. A mixed cirrhotic etiology increased the risk of rebleeding, and portal vein thrombosis and high MELD score increased the risk of mortality.