Prophylactic endoscopic therapy for variceal bleeding in patients with hepatocellular carcinoma

Abstract

Background & Aims: To evaluate the efficacy and timing of secondary prophylactic endoscopic therapy for variceal bleeding. To determine the long-term survival and identify the prognostic factors in patients with hepatocellular carcinoma. Methods: A Retrospective study was conducted. We included patients with concurrent hepatic carcinoma who received endoscopic therapy for variceal bleeding. A Kaplan-Meier survival analysis was performed. Potential factors for prediction were compared with Cox's proportional hazard model analysis. Results: 192 patients were included between January 2008 and December 2014. During follow-up (median 17 months), 102 patients presented with an episode of rebleeding. The cumulative 6-month, 1- and 5-year rebleeding rates were 40.9%, 49.3% and 71.2%. A total of 98 patients died during follow-up. The overall 6-month, 1-and 5-year cumulative mortality rates were 33.5%, 45.8% and 65.7%. BCLC C/D stage (P=0.035, HR=1.53, 95% CI 1.003-2.327) was an independent predictor of bleeding relapse, while BCLC C/D staging (P=0.035, HR=1.59, 95% CI 1.033-2.454) and male gender (P=0.007, HR=1.58, 95% CI 1.135-2.198) predicted shorter survival times. Combination ligation and cyanoacrylate was associated with a decreased rebleeding and mortality rate in patients with both esophageal and gastric varices (P=0.003). The start time of the initial endoscopic procedure did not affect treatment efficacy. Conclusions: Ligation combined with cyanoacrylate could be preferred for HCC patients presented with both esophageal and gastric varices. BCLC C/D stage predicted shorter survival times and bleeding relapse, while male gender was an independent predictor of poor survival.