Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: a propensity score-weighted analysis from a single institution.
Aged
Balloon Occlusion
/ methods
Digestive System Surgical Procedures
/ methods
Esophageal and Gastric Varices
/ etiology
Female
Gastrointestinal Hemorrhage
/ etiology
Humans
Hypertension, Portal
/ complications
Male
Middle Aged
Prognosis
Propensity Score
Recurrence
Retrospective Studies
Risk Factors
Splenectomy
/ methods
Survival Rate
Treatment Outcome
Balloon-occluded transvenous obliteration
Gastric devascularization
Gastric varices
Portal hypertension
Splenectomy
Journal
Journal of gastroenterology
ISSN: 1435-5922
Titre abrégé: J Gastroenterol
Pays: Japan
ID NLM: 9430794
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
04
08
2019
accepted:
02
06
2020
pubmed:
14
6
2020
medline:
25
2
2023
entrez:
14
6
2020
Statut:
ppublish
Résumé
Although balloon-occluded retrograde transvenous obliteration (BRTO) is often selected to treat gastric varices caused by portal hypertension, data comparing BRTO and splenectomy with gastric devascularization (Sp + Dev) are limited. From January 2009 to February 2018, 100 patients with gastric varices caused by portal hypertension who underwent Sp + Dev (n = 45) or BRTO (n = 55) were included. Overall survival (OS) and the rebleeding rate were calculated using the inverse probability of a treatment weighting-adjusted log-rank test. Independent risk factors were identified by Cox regression analysis. Changes in liver function and adverse events after the procedures were analyzed. Patients in the Sp + Dev group tended to have lower platelet counts than those in the BRTO group, but liver function did not differ between these groups. The 5-year OS rates for the Sp + Dev and BRTO groups were 73.4 and 50.0% (p = 0.005), respectively. There were no significant differences in rebleeding rates between the two groups. Multivariate analysis showed that serum albumin level ≤3.6 g/dL, prothrombin time% activity (PT%) ≤80%, and serum creatinine level ≥0.84 mg/dL were poor prognostic factors. Although the Sp + Dev group had more short-term complications after procedures, Sp + Dev tended to be more effective in improving liver function than BRTO. Sp + Dev showed better OS and improvement of liver function compared with BRTO for the treatment of gastric varices caused by portal hypertension.
Sections du résumé
BACKGROUND
BACKGROUND
Although balloon-occluded retrograde transvenous obliteration (BRTO) is often selected to treat gastric varices caused by portal hypertension, data comparing BRTO and splenectomy with gastric devascularization (Sp + Dev) are limited.
METHODS
METHODS
From January 2009 to February 2018, 100 patients with gastric varices caused by portal hypertension who underwent Sp + Dev (n = 45) or BRTO (n = 55) were included. Overall survival (OS) and the rebleeding rate were calculated using the inverse probability of a treatment weighting-adjusted log-rank test. Independent risk factors were identified by Cox regression analysis. Changes in liver function and adverse events after the procedures were analyzed.
RESULTS
RESULTS
Patients in the Sp + Dev group tended to have lower platelet counts than those in the BRTO group, but liver function did not differ between these groups. The 5-year OS rates for the Sp + Dev and BRTO groups were 73.4 and 50.0% (p = 0.005), respectively. There were no significant differences in rebleeding rates between the two groups. Multivariate analysis showed that serum albumin level ≤3.6 g/dL, prothrombin time% activity (PT%) ≤80%, and serum creatinine level ≥0.84 mg/dL were poor prognostic factors. Although the Sp + Dev group had more short-term complications after procedures, Sp + Dev tended to be more effective in improving liver function than BRTO.
CONCLUSIONS
CONCLUSIONS
Sp + Dev showed better OS and improvement of liver function compared with BRTO for the treatment of gastric varices caused by portal hypertension.
Identifiants
pubmed: 32533300
doi: 10.1007/s00535-020-01693-9
pii: 10.1007/s00535-020-01693-9
pmc: PMC7289714
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
877-887Subventions
Organisme : Japan Society for the Promotion of Science (JP)
ID : JP17K10669
Organisme : AMED
ID : JP18fk0210007
Organisme : AMED
ID : 19fk0310109h0003
Organisme : AMED
ID : 19fk0210020h0003
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