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J Cancer. 2019 Jun 2;10(14):3087-3093. doi: 10.7150/jca.30434. eCollection 2019.

Prophylactic Endoscopic Therapy for Variceal Bleeding in Patients with Hepatocellular Carcinoma.

Chen J1,2, Tseng Y3, Luo T1,2, Li N4, Ma L5, Chen S1,2,5.

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Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Liver Disease, Shanghai, China.
Department of Digestive diseases, Huashan Hospital, Fudan University, Shanghai, China.
Department of Infectious diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Endoscopy Center and Endoscopy Research Institute, Fudan University, Shanghai, China.


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.


Hepatocellular carcinoma; endoscopic therapy; liver cirrhosis; variceal bleeding

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

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