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Prognosis of endotherapy versus splenectomy and devascularization for variceal bleeding in patients with hepatitis B-related cirrhosis.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Jun2021, Vol. 35 Issue 6, p2620-2628. 9p. - Publication Year :
- 2021
-
Abstract
- <bold>Objective: </bold>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).<bold>Materials and Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CHRONIC hepatitis B
*HEMORRHAGE
*SURVIVAL rate
*SPLENECTOMY
*OPERATIVE surgery
*PROPENSITY score matching
*HEPATITIS B
*RESEARCH
*GASTROINTESTINAL hemorrhage
*RESEARCH methodology
*ESOPHAGEAL varices
*CIRRHOSIS of the liver
*PROGNOSIS
*CANCER relapse
*MEDICAL cooperation
*EVALUATION research
*DISEASE relapse
*TREATMENT effectiveness
*COMPARATIVE studies
*RESEARCH funding
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 35
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 150305201
- Full Text :
- https://doi.org/10.1007/s00464-020-07682-6