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Prognosis of endotherapy versus splenectomy and devascularization for variceal bleeding in patients with hepatitis B-related cirrhosis

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Abstract

Objective

This study aimed to compare the long-term outcome of endotherapy versus a combination of splenectomy and devascularization for variceal bleeding in patients with hepatitis B-related cirrhosis (HBRC).

Materials and methods

A total of 1074 patients with HBRC and acute variceal bleeding (AVB) treated with endotherapy and 248 patients with HBRC treated with a combination of splenectomy and devascularization surgery were included in the analysis. After one-to-one propensity score matching, 151 paired patients were selected. The primary end-point was death. The secondary outcomes were 3-year survival, 5-year survival, and rebleeding. Complications were recorded.

Results

The median follow-up time was 1165 days in the endoscopic group and 1709 days in the surgical group. Before matching, the 1-year, 3-year, and 5-year survival rates were significantly lower in the endoscopic group than in the surgical group (91.1 vs 96.3%, P = 0.017; 79.6 vs 91.6%, P = 0.001; 65.2 vs 81.3%, P = 0.001). After matching, no significant differences were found between groups (94.5 vs 95.2%, P = 0.767; 87.0 vs 88.9%, P = 0.635; 77.9 vs 77.9%, P = 0.905). The rebleeding rate was lower in the surgical group than in the endoscopic group; the rebleeding-free survival rate was similar in the two groups. No patient died of complications. No statistically significant difference was observed in complications between groups.

Conclusions

Both endotherapy and a combination of splenectomy and devascularization are good choices for patients with AVB. The rebleeding rate was lower after the surgical procedure, but the long-term prognosis was similar.

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Abbreviations

AFP:

Alpha-fetoprotein

ALB:

Albumin

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

AST:

Aspartate transferase

AVB:

Acute variceal bleeding

CHE:

Cholinesterase

Cr:

Creatinine

CT:

Computed tomography

EIS:

Endoscopic injection sclerotherapy

EVL:

Endoscopic variceal ligation

HCC:

Hepatocellular carcinoma

HBRC:

Hepatitis B-related cirrhosis

HGB:

Hemoglobin

GGT:

Gamma-glutamyl transpeptidase

GOV:

Gastroesophageal varices

IGV:

Isolated gastric varices

LYM:

Lymphocyte

MELD:

Model for end-stage liver disease

NEU%:

Neutrophilic granulocyte percentage

PLT:

Platelet

PT:

Prothrombin time

PVT:

Portal vein thrombosis

PSM:

Propensity score matching

PS:

Propensity score

RBC:

Red blood cell

TIPS:

Transjugular intrahepatic portosystemic shunt

TBIL:

Total bilirubin

WBC:

White blood cell

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Acknowledgements

The authors thank Dr. Rong He for helping with statistical data and other colleagues for collecting clinical data.

Funding

This study was supported by the grants from the Science Foundation of Capital Medicine Development (2014-2-2171), the Capital Foundation for Clinical Characteristic Applied Research Projects (Z141107002514132), the Capital Foundation for Clinical Characteristic Applied Research Projects (Z181100001718084), and the Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (XXZ0404) to Prof. Wei.

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Author notes

  1. Li Jiang and Hong-shan Wei have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Str.Chaoyang, Beijing, 100015, China

    Jia-li Ma, Ling-ling He, Ping Li & Hong-shan Wei

  2. Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China

    Li Jiang

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  1. Jia-li Ma
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Contributions

WH designed the present study. MJ, JL, and HL collected the clinical data. MJ, JL, HL, and LP performed the statistical analysis. MJ and JL wrote the manuscript. All authors read and approved the final manuscript. All authors had access to the study data and had reviewed and approved the final manuscript.

Corresponding author

Correspondence to Hong-shan Wei.

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Disclosure

I confirm that the information reported above are accurate and Drs. Hong-shan Wei, Li Jiang, Jia-li Ma, Ling-ling He and Ping Li have no conflicts of interest or financial ties to disclose. All of the authors (Jia-li Ma, Ling-ling He, Ping Li, Li Jiang, and Hong-shan Wei) declare no conflicts of interest with regard to the content of this study.

Ethics approval and consent to participate

This retrospective study was approved by the Clinical Ethics Committees of Beijing Ditan Hospital, Capital Medical University (JDLKZ2018-021–01). All patients provided written informed consent in accordance with the Declaration of Helsinki.

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Ma, Jl., He, Ll., Li, P. et al. Prognosis of endotherapy versus splenectomy and devascularization for variceal bleeding in patients with hepatitis B-related cirrhosis. Surg Endosc 35, 2620–2628 (2021). https://doi.org/10.1007/s00464-020-07682-6

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