IDDF2020-ABS-0032 Clinical determinants of multidisciplinary intervention and prolonged endoscopic therapy in eradicating high-risk esophagogastric varices

Background High-risk esophagogastric varices (EGV) are prone to bleeding and are recommended to be eradicated through endoscopic therapy by practice guideline. However, a considerable number of patients may fail the endoscopic variceal eradication (VE) when second-line non-endoscopic treatments, including radio-interventional and surgical therapy are required. To date, predictive factors for the multidisciplinary therapy switch are unclear. We aimed to investigate factors that determine the therapy switch and the length of endoscopic therapy to VE. Methods We carried out this retrospective study based on an established cohort of cirrhosis recruiting patients from 2011 to 2018. Relevant medical and endoscopic data were collected and comprehensively assessed. Multivariate analyses were performed to identify factors associated with the therapy switch in all included patients, and the length of time to VE in endoscopic VE-achieved patients. Results A total of 330 patients were included for analysis, of which 289 cases (87.6%) achieved VE through sequential endoscopic therapies. The median (Interquartile range, IQR) time to VE was 5 (2–10.5) months and the median (IQR) number of endoscopic sessions required was 3 (2–5). Meanwhile, thirty-two cases (9.7%) failed endoscopic VE and transferred to multidisciplinary therapy during endoscopic intervals (25 cases for surgical therapy and 7 cases for radio-interventional therapy). Multivariate analysis showed that splenomegaly (hazard ratio, HR 1.21, 95%CI 1.09–1.34), portal vein thrombosis (HR 2.88, 95%CI 1.20–6.88) and thrombocytopenia (HR 0.99, 95%CI 0.97–1.00) were associated with the therapy switch. Among endoscopic VE-achieved patients, male sex (HR 1.49, 95%CI 1.12–1.99), large varices (HR 4.01, 95%CI 2.22–7.23), long-segment varices (HR 1.70, 95%CI 1.04–2.78), and intercurrent bleeding (HR 2.24, 95%CI 1.53–3.30) were associated with prolonged time required for VE. Conclusions Patients with an enlarged spleen, portal vein thrombosis and low platelet count are at high risk of undergoing multidisciplinary therapy to eradicate EGV. Severe varices, male sex and interval bleeding event impair endoscopic efficacy significantly. Our findings may help improve patient risk stratification and medical resources allocation.