食道胃静脈瘤出血が失調イベントとして初めて発生した患者における内視鏡的逐次療法の長期予後

Limited data exist regarding the portal hypertension progression in cirrhotic patients with variceal bleeding as the initial decompensation event. This study evaluated the impact of sequential endoscopic therapy on long-term clinical outcomes.

196 hospitalized cases were included and divided into EV, GOV1, GOV2, and GOV3 groups. Fine-Gray test was used to analyze the cumulative incidence of outcome events. Survival was calculated using the Kaplan-Meier method, and the Cox proportional risk regression model was used for multivariate analysis of factors affecting outcomes.

During a median follow-up period of 104.9 months, distinct cumulative outcomes were observed across esophageal and gastric variceal subtypes. The 1-, 3-, and 5-year cumulative rebleeding rates progressively increased across subtypes: EV (16.2%, 29.7%, 41.9%), GOV1 (18.8%, 39.6%, 45.8%), GOV2 (19.1%, 34.0%, 46.8%), and GOV3 (44.4%, 63.0%, 66.7%) (Gray's test, p=0.009). Corresponding survival rates demonstrated an inverse pattern, declining with longer follow-up: EV (91.9%, 82.4%, 58.1%), GOV1 (91.7%, 79.2%, 60.4%), GOV2 (91.5%, 76.6%, 55.3%), and GOV3 (74.1%, 55.6%, 48.1%) (log-rank test, p=0.016). Rebleeding was an independent risk factor associated with survival (HR: 3.518, p < 0.001). Multivariate analysis showed that CTP score, varices shape, varices type, and the number of endoscopic treatments (whether > 3) were significant risk factors for rebleeding (p < 0.05).

In this study, rebleeding dominated the clinical course of different subtypes and was the only independent predictor of death. More aggressive treatments, such as salvage TIPS, should be considered in patients who were at higher risk of rebleeding.