Liver cirrhosis is the main cause of
portal hypertension. The leading cause of death in patients with
liver cirrhosis is its most common complication, esophageal variceal
bleeding (EVB). Endoscopic variceal
ligation (EVL) is recommended by many guidelines to treat EVB and prevent rebleeding; however, esophageal
ulcers occur
after treatment. Delayed healing of
ulcers and unhealed
ulcers lead to high rebleeding and mortality rates. Thus, the prevention of early postoperative rebleeding is of great significance in improving the quality of life and prognosis of patients.
AIM: The medical records of 792 patients who were diagnosed with EVB and in whom
bleeding was successfully stopped by EVL at Shenzhen People's Hospital, Guangdong Province, China from January 2015 to December 2020 were collected. According to the study inclusion and exclusion criteria, 401 cases were included in a PPI-monotherapy group (PPI group), and 377 cases were included in a PPI and APG combination
therapy (PPI + APG) group. We compared the incidence rates of early rebleeding and other complications within 6 wk
after treatment between the two groups. The two-sample t-test, Wilcoxon rank-sum test, and chi-squared test were adopted for statistical analyses.
RESULTS: No significant differences in age, sex, model for
end-stage liver disease score, coagulation function,
serum albumin level, or
hemoglobin level were found between the two groups. The incidence of early rebleeding in the PPI + APG group (9/337; 2.39%) was significantly lower than that in the PPI group (30/401; 7.48%) (P = 0.001). Causes of early rebleeding in the PPI group were esophageal
ulcer (3.99%, 16/401) and
esophageal varices (3.49%, 14/401), while those in the PPI + APG group were also esophageal
ulcers (5/377; 1.33%) and
esophageal varices (4/377; 1.06%); such causes were significantly less frequent in the PPI + APG group than in the PPI group (P = 0.022 and 0.024, respectively). The early mortality rate within 6 wk in both groups was 0%, which was correlated with the timely
rehospitalization of all patients with rebleeding and the conduct of emergency endoscopic
therapy. The incidence of adverse events other than early
bleeding in the PPI + APG group (28/377; 7.43%) was significantly lower than that in the PPI group (63/401; 15.71%) (P < 0.001). The incidence of
chest pain in the PPI + APG group (9/377; 2.39%) was significantly lower than that in the PPI group (56/401; 13.97%) (P < 0.001). The incidence of
constipation in the PPI + APG group (16/377; 4.24%) was significantly higher than that in the PPI group (3/401; 0.75%) (P = 0.002) but
constipation was relieved after patients drank more water or took
lactulose. In the PPI and PPI + APG groups, the incidence rates of spontaneous
peritonitis within 6 wk after discharge were 0.50% (2/401) and 0.53% (2/377), respectively, and those of
hepatic encephalopathy were 0.50% (2/401) and 0.27% (1/377), respectively, presenting no significant difference (P > 0.999).
CONCLUSION: