Clinical significance of isolated gastric varices in liver cirrhotic patients: A single‐referral‐centre retrospective cohort study

• Published in: JGH open Vol. 4; no. 3; pp. 511 - 518
• Main Authors: Lesmana, Cosmas Rinaldi A, Kalista, Kemal F, Sandra, Sharon, Hasan, Irsan, Sulaiman, Andri Sanityoso, Kurniawan, Juferdy, Jasirwan, Chyntia O M, Nababan, Saut H, Lirendra, Mutiara, Aprilicia, Gita, Gani, Rino A
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.06.2020; John Wiley & Sons, Inc; Wiley
• Subjects: Age; bleeding; Classification; Clinical significance; Cohort analysis; Esophagus; Etiology; gastric varices; liver cirrhotic patients; Liver diseases; Medical records; Mortality; mortality rate; Original; Risk factors; liver cirrhotic patients; bleeding; gastric varices; mortality rate
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12292

Introduction Gastric varices (GVs) occur in 10–30% of liver cirrhotic patients, with a mortality rate of up to 45%. Rupture of isolated GVs (IGVs) is less prevalent but often results in more severe hemorrhage and a higher risk of mortality than rupture of esophageal varices (EVs). However, there is no clear consensus yet about the optimal management for incidentally discovered IGVs. Objective To determine the clinical significance of IGVs in liver cirrhotic patients. Methods This was a retrospective cohort endoscopy database study within a 2‐year period (2016–2017). All study subjects were liver cirrhotic patients with OVs or GVs. The exclusion criteria were noncirrhotic portal hypertension, presence of malignancy, absence of varices, and incomplete data. Statistical analysis was performed using IBM SPSS 23. Results A total of 153 patients were included in this study. IGVs were found in 13 (8.49%) patients, whereas OVs were found in 112 (73.20%) patients and gastro‐OVs were found in 28 (18.30%) patients. Child‐Pugh class C (CP C) score was the strongest independent risk factor for variceal bleeding in bivariate analysis (hazard ratio [HR]: 10.21, 95% confidence interval [CI]: 4.15–25.12, P = 0.001) and multivariate analysis (HR: 12.49, 95% CI: 4.95–31.54, P 0.001); however, the presence of IGVs was not an independent risk factor. CP C score was also the only significant risk factor associated with 1‐year mortality in liver cirrhotic patients on multivariate analysis (HR: 26.77, 95% CI: 6.01–119.34, P 0.001). Conclusion The presence of IGVs has no clinical significance in the occurrence of 1‐year rebleeding and in patient survival. There is no clinical significance of isolated gastric varix (IGV) in cirrhosis patient. The presence of gastroesophageal varix (GOV) seemed to be important factor for 1‐year bleeding occurrence, but not on survival in liver cirrhosis patients. The most important risk factor for 1‐year bleeding occurrence and survival is Child Pugh C score.