Abstract
BACKGROUND: There is limited literature on the long-term outcomes of patients with cirrhosis following an index gastric variceal (GV) hemorrhage. METHODS: Patients with cirrhosis and hemorrhage from gastroesophageal varices type-2 (GOV-2) or isolated gastric varices type-1 (IGV-1) from two tertiary care centers over 8 years were retrospectively analyzed. All patients underwent endoscopic cyanoacrylate injection (ECI) for primary hemostasis. Modalities of secondary prophylaxis included endoscopic surveillance and beta-blockers (ECI and BBs), balloon-occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS). The incidence of rebleeding, mortality, and further decompensation among patients receiving ECI and BB was estimated and compared with a propensity score-matched (PSM) cohort of patients undergoing BRTO or TIPS. RESULTS: Three hundred and fifty-one patients were recruited. Of those 275 received ECI and BB, 54 underwent BRTO, and 22 underwent TIPS. The rebleeding rate at 1 year after ECI and BB was 19.2%, while the 1-year mortality and further decompensation rates were 19.7% and 27.8%, respectively. Rebleeding predominantly occurred from GV (76.1% of cases), with the cumulative 1-, 3-, and 5-year all-cause rebleeding rate among patients receiving ECI alone being 19.2%, 30%, and 35%, respectively. BRTO and TIPS significantly reduced all-cause rebleeding, but were associated with similar rates of further decompensation and mortality compared to ECI and BB in the PSM cohort. CONCLUSION: BRTO and TIPS significantly reduce all-cause rebleeding as compared to ECI and BB, but their impact on further decompensation and overall survival requires further evaluation in larger cohorts.