Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data

• Main Authors: Moon Young Kim, Soon Ho Um, Soon Koo Baik, Yeon Seok Seo, Soo Young Park, Jung Il Lee, Jin Woo Lee, Gab Jin Cheon, Joo Hyun Sohn, Tae Yeob Kim, Young Suk Lim, Tae Hyo Kim, Tae Hee Lee, Sung Jae Park, Seung Ha Park, Jin Dong Kim, Sang Young Han, Chang Soo Choi, Eun Young Cho, Dong Joon Kim, Jae Seok Hwang, Byoung Kuk Jang, June Sung Lee, Sang Gyune Kim, Young Seok Kim, So Young Kwon, Won Hyeok Choe, Chang Hyeong Lee, Byung Seok Kim, Jae Young Jang, Soung Won Jeong, Byung Ho Kim, Jae Jun Shim, Yong Kyun Cho, Moon Soo Koh, Hyun Woong Lee
• Format: Article
• Language: English
• Published: Korean Association for the Study of the Liver 2013-03-01
• Series: Clinical and Molecular Hepatology
• Subjects: Gastric variceal bleeding; Rebleeding; Mortality; Cirrhosis
• Online Access: http://e-cmh.org/upload/pdf/cmh-19-36.pdf

Background/AimsWhile gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea.MethodsThe data of 1,308 episodes of GVB (males:females=1062:246, age=55.0±11.0 years, mean±SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated.ResultsThe initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001).ConclusionsThe clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.