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Zhang W, Huang Y, Xiang H, Zhang L, Yuan L, Wang X, Dang T, Zhang G, Hu S, Liu C, Zhang X, Peng L, Gao M, Xia D, Li J, Song Y, Zhou X, Qi X, Zeng J, Tan X, Deng M, Fang H, Qi S, He S, He Y, Ye B, Wu W, Shao J, Wei W, Hu J, Yong X, He C, Bao J, Zhang Y, Ji R, Bo Y, Yan W, Li H, Wang Y, Wang Y, Li M, Lian J, Liu C, Wu Y, Gu Y, Wang Y, Cao P, Wu B, Ren L, Pan H, Liang Y, Tian S, Lu L, Fang Y, Jiang P, Liu Z, Liu A, Zhao L, Li S, Qiao J, Sun L, Li M, Fang C, Chen H, Tian Z, Lin G, Huang X, Chen J, Deng Y, Lv M, Liao J, Zhang L, Lu J, Wu S, Yang X, Guo W, Wang J, Chen C, Huang E, Yu Y, Yang M, Cheng S, Yang Y, Wu X, Rang L, Han P, Zhang Y, Li X, Wang F, McAlindon ME, Seto WK, Lv C, Rockey DC, Qi X. Timing of endoscopy for acute variceal bleeding in patients with cirrhosis (CHESS1905): A nationwide cohort study. Hepatol Commun 2023; 7:02009842-202305010-00023. [PMID: 37141513 PMCID: PMC10162790 DOI: 10.1097/hc9.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 02/14/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Endoscopy plays an important role in the management of acute variceal bleeding (AVB) in patients with cirrhosis. This study aimed at determining the optimal endoscopy timing for cirrhotic AVB. METHODS Patients with cirrhosis with AVB across 34 university hospitals in 30 cities from February 2013 to May 2020 who underwent endoscopy within 24 hours were included in this study. Patients were divided into an urgent endoscopy group (endoscopy <6 h after admission) and an early endoscopy group (endoscopy 6-24 h after admission). Multivariable analysis was performed to identify risk factors for treatment failure. Primary outcome was the incidence of 5-day treatment failure. Secondary outcomes included in-hospital mortality, need for intensive care unit, and length of hospital stay. A propensity score matching analysis was performed. In addition, we performed an analysis, in which we compared the 5-day treatment failure incidence and the in-hospital mortality among patients with endoscopy performed at <12 hours and 12-24 hours. RESULTS A total of 3319 patients were enrolled: 2383 in the urgent endoscopy group and 936 in the early endoscopy group. After propensity score matching, on multivariable analysis, Child-Pugh class was identified as an independent risk factor for 5-day treatment failure (HR, 1.61; 95% CI: 1.09-2.37). The incidence of 5-day treatment failure was 3.0% in the urgent endoscopy group and 2.9% in the early group ( p = 0.90). The in-hospital mortality was 1.9% in the urgent endoscopy group and 1.2% in the early endoscopy group ( p = 0.26). The incidence of need for intensive care unit was 18.2% in the urgent endoscopy group and 21.4% in the early endoscopy group ( p = 0.11). The mean length of hospital stay was 17.9 days in the urgent endoscopy group and 12.9 days in the early endoscopy group ( p < 0.05). The incidence of 5-day treatment failure in the <12-hour group was 2.3% and 2.2% in the 12-24 hours group ( p = 0.85). The in-hospital mortality was 2.2% in the <12-hour group and 0.5% in the 12-24 hours group ( p < 0.05). CONCLUSIONS The data suggest that performance of endoscopy within 6-12 or within 24 hours of presentation among patients with cirrhosis with AVB led to similar treatment failure outcomes.
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Affiliation(s)
- Wenhui Zhang
- Digestive System Department, Beijing Daxing District People's Hospital, Beijing, China
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yifei Huang
- Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Huiling Xiang
- Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin, China
| | - LiYao Zhang
- CHESS Center, The Sixth People's Hospital of Shenyang Shenyang, China
| | - Lili Yuan
- Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China
| | - Xing Wang
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tong Dang
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Guo Zhang
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shengjuan Hu
- Department of Gastroenterology, Endoscopic Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Chuan Liu
- Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xiuping Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lijun Peng
- Department of Gastroenterology, Linyi People's Hospital, Linyi, China
| | - Min Gao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongli Xia
- Department of Gastroenterology, Chongqing University Fuling Hospital, Chongqing, China
| | - Jia Li
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Ying Song
- Department of Gastroenterology, Xi'an GaoXin Hospital, Xi'an, China
| | - Xiqiao Zhou
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xingsi Qi
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Zeng
- Department of Emergency, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Xiaoyan Tan
- Department of Gastroenterology, Maoming People's Hospital, Maoming, China
| | - Mingming Deng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haiming Fang
- Department of Gastroenterology and Hepatology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shenglin Qi
- Department of Hepatology, Dalian Sixth People's Hospital, Dalian, China
| | - Song He
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongfeng He
- Department of Gastroenterology, Endoscopic Center, Ankang Central Hospital, Ankang, China
| | - Bin Ye
- Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Wei Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiangbo Shao
- Department of Liver Disease, The Third People's Hospital of Zhenjiang, Zhenjiang, China
| | - Wei Wei
- Gastroenterology Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jianping Hu
- Department of Gastroenterology, First People's Hospital of Yinchuan City, Yinchuan, China
| | - Xin Yong
- Gastroenterology, General Hospital of Western Theater Command, Chengdu, China
| | - Chaohui He
- Department of Gastroenterology and Endoscopy, The Fifth Affiliated Zhuhai Hospital of Zunyi Medical University, Zhuhai, China
| | - Jinlun Bao
- Department of Gastroenterology, Shannan People's Hospital, Shannan, China
| | - Yuening Zhang
- Center of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Rui Ji
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yang Bo
- Department of Hepatobiliary Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Wei Yan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongjiang Li
- Department of Hepatology, Baoding People's Hospital, Baoding, China
| | - Yong Wang
- Department of Interventional Radiology, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
- Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
| | - Yanling Wang
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Mengmeng Li
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jia Lian
- Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin, China
| | - Chang'en Liu
- Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin, China
| | - Yunhai Wu
- CHESS Center, The Sixth People's Hospital of Shenyang Shenyang, China
| | - Ye Gu
- CHESS Center, The Sixth People's Hospital of Shenyang Shenyang, China
| | - Yan Wang
- CHESS Center, The Sixth People's Hospital of Shenyang Shenyang, China
| | - Ping Cao
- Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China
| | - Bin Wu
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Limei Ren
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Hongduo Pan
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yunxiao Liang
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shuni Tian
- Department of Gastroenterology, Linyi People's Hospital, Linyi, China
| | - Lin Lu
- Department of Gastroenterology, Linyi People's Hospital, Linyi, China
| | - Yanfei Fang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pan Jiang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenbei Liu
- Department of Gastroenterology, Chongqing University Fuling Hospital, Chongqing, China
| | - Aimin Liu
- Department of Gastroenterology, Chongqing University Fuling Hospital, Chongqing, China
| | - Lili Zhao
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Shuang Li
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Jinggui Qiao
- Department of Gastroenterology, Xi'an GaoXin Hospital, Xi'an, China
| | - Lihui Sun
- Department of Gastroenterology, Xi'an GaoXin Hospital, Xi'an, China
| | - Mengyu Li
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chengwen Fang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zibin Tian
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Gaoyang Lin
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuanhui Huang
- Department of Emergency, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Jitao Chen
- Department of Gastroenterology, Maoming People's Hospital, Maoming, China
| | - Ying Deng
- Department of Gastroenterology, Maoming People's Hospital, Maoming, China
| | - Muhan Lv
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingyuan Liao
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lijiu Zhang
- Department of Gastroenterology and Hepatology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Junyu Lu
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suhua Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaocui Yang
- Department of Gastroenterology, Endoscopic Center, Ankang Central Hospital, Ankang, China
| | - Wenwei Guo
- Department of Gastroenterology, Endoscopic Center, Ankang Central Hospital, Ankang, China
| | - Jianbo Wang
- Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Chao Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Erjiong Huang
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuehua Yu
- Department of Gastroenterology, First People's Hospital of Yinchuan City, Yinchuan, China
| | - Ming Yang
- Gastroenterology, General Hospital of Western Theater Command, Chengdu, China
| | - Shuangping Cheng
- Gastroenterology, General Hospital of Western Theater Command, Chengdu, China
| | - Yang Yang
- Department of Gastroenterology and Endoscopy, The Fifth Affiliated Zhuhai Hospital of Zunyi Medical University, Zhuhai, China
| | - Xiaoli Wu
- Department of Gastroenterology, Shannan People's Hospital, Shannan, China
| | - Limaocai Rang
- Department of Gastroenterology, Shannan People's Hospital, Shannan, China
| | - Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanmin Zhang
- Department of Hepatology, Baoding People's Hospital, Baoding, China
| | - Xiaoguo Li
- Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Fengmei Wang
- Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin, China
| | - Mark Edward McAlindon
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Wai-Kay Seto
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chuanzhu Lv
- Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Don C Rockey
- Division of Gastroenterology and Hepatology, Medical University South Carolina, Charleston, South Carolina, USA
| | - Xiaolong Qi
- Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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