IDDF2019-ABS-0046 Endoscopic practice of variceal eradication in chinese liver center

Background Esophagogastric varices (EGV) is a major consequence of portal hypertension highly associated with dreadful variceal hemorrhage, and complete variceal eradication may greatly improve recurrence and prognosis. Little is known about the endoscopic resources invested for EGV eradication in China. This observational study aimed to clarify the practice of variceal eradication by modern combination endoscopic strategies and investigate factors associated with treatment sessions. Methods Clinical data were extracted from the endoscopic recording database and medical charts. Cirrhotic patients underwent the initial endoscopic treatment in our department and followed up for more than 2 months were included between Oct 2011 to Jun 2018. Endoscopic sequential therapy (EST) is an integrated protocol comprising endoscopic cyanoacrylate injection (ECI) sequenced by repeated sessions of endoscopic band ligation (EBL) and/or endoscopic injection sclerotherapy (EIS), and this protocol was performed for every patient. Patients were intensively followed up until complete EGV eradication. Results Among the 337 patients recruited to follow up, 291 (86.4%) who successfully reached variceal eradication were included for analysis. A total of 1029 episodes of endoscopic treatments were performed for the patients. Among them, 132 (45.4%) patients had Child-Pugh class B or C liver disease, and 46 (15.8%) had MELD score equal or over 15. EBL was the most prevalent method used in 283 (97%) patients, followed by ECI for 121 patients (41.6%) and EIS for 53 patients (18.2%). A mean 3.5 sessions of endoscopic therapy was needed to reach complete variceal eradication during an average of 9.6 months (range, 24 days-75 months). The median endoscopic interval between sessions for each patient was 2.0 months (IQR 1.3–3.0). There was a significant positive association between portal vein diameter and both the number of endoscopic sessions (P Conclusions Most cirrhotic patients with EGV undergoing EST would achieve variceal eradication. EVL is the mainstay of the endoscopic method. Portal vein diameter is related to endoscopic resources invested for variceal eradication. Interval between sessions is far from optimal in China and physicians should pay more attention to patient compliance in clinical practice.