Nationwide survey analysis of esophagogastric varices in portal hypertension based on endoscopic management in China

Abstract Aims The endoscopic treatment of esophagogastric varices is challenging, and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains unclear. This study investigated the use of endoscopic therapy for portal hypertension in China. Methods This study used a questionnaire survey initiated by the Liver Health Consortium in China to investigate the use of endoscopic therapies for portal hypertension. Questionnaires were released online from January 30, 2023 to February 28, 2023 and filled out by chief physicians or senior instructors responsible for endoscopic therapies in participating hospitals across 31 provinces (autonomous regions and municipalities) in China. Comparisons of guideline adherence between primary and referral medical centers were performed using the chi‐square test or Fisher's exact test. Results In total, 836 hospitals participated in the survey. For primary and secondary prophylaxis of esophagogastric variceal bleeding (EGVB), adherence to the national guidelines was 72.5% (606/836) and 39.2% (328/836), respectively. Significant differences were observed in the rate of adherence between the primary and referral centers for primary (79.9% [111/139] vs. 71.0% [495/697], p = 0.033) and secondary prophylaxis (27.3% [38/139] vs. 41.6% [290/697], p = 0.002). Of the hospitals, 78.2% (654/836) preferred endoscopic therapies for acute EGVB, and the timing of endoscopy was usually within 12 h (48.5%, 317/654) and 12–24 h (36.9%, 241/654) after bleeding. Endoscopic therapy was more likely to be the first choice of treatment for acute EGVB in referral centers than in primary centers (82.6% [576/697] vs. 56.1% [78/139], p < 0.001). Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, the most prevalent procedures were cyanoacrylate injection combined with sclerotherapy (48.2% [403/836] and 29.9% [250/836], respectively); however, substantial hospitals preferred clip‐assisted therapies (12.4% [104/836] and 26.4% [221/836], respectively). Nonselective beta‐blockers were routinely used in 73.4% (614/836) of hospitals during the perioperative period of EGVB management, and propranolol (88.8%, 545/614) and carvedilol (37.5%, 230/614) were the most widely used nonselective beta‐blockers. Conclusions This survey clarified that various endoscopic procedures have been implemented nationwide in China. Participating hospitals have actively performed emergent endoscopy for acute EGVB; however, these hospitals do not adequately follow recommendations regarding primary and secondary prophylaxis of EGVB. In the future, standardizing the selection of endoscopic procedures and improving compliance with guidelines is crucial.

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Journal
Portal hypertension & cirrhosis
Published
2024-09-01
DOI
https://doi.org/10.1002/poh2.91
Citations
3
Primary Topic
Liver Disease and Transplantation
Type
article
Field-Weighted Citation Impact
1.11

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article

Nationwide survey analysis of esophagogastric varices in portal hypertension based on endoscopic management in China

Zhijie Feng, Xiaolong Qi, Yanjing Gao, Xiaoquan Huang et al.
3 citations
Portal hypertension & cirrhosis
Liver Disease and Transplantation
1.11
article

Nationwide survey analysis of esophagogastric varices in portal hypertension based on endoscopic management in China

Zhijie Feng, Xiaolong Qi, Yanjing Gao, Xiaoquan Huang, Ji-Tao Song, Shengjuan Hu, Derun Kong, Dean Tian, Xing Wang, Xiaodong Zhou, Tong Dang, Huiling Xiang, Weichun Lin, Bin Wu, Lili Yuan, Zhining Fan, Bing-Rong Liu, Liangzhi Wen, Liang-Bi Xu, Xiaowei Liu, Wenhui Zhang, Jinhai Wang, Ligang Chen, Feng Ji, Xiaoliang Zhu, Yiling Li, Hong Xu, Yifei Huang, B. Y. Hu, Feihu Bai, Yinglei Miao, Ping Yao, Yingcai Ma, Yunxiao Liang, Yangzhen Bian Ba
article en
3 citations

Abstract

Abstract Aims The endoscopic treatment of esophagogastric varices is challenging, and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains unclear. This study investigated the use of endoscopic therapy for portal hypertension in China. Methods This study used a questionnaire survey initiated by the Liver Health Consortium in China to investigate the use of endoscopic therapies for portal hypertension. Questionnaires were released online from January 30, 2023 to February 28, 2023 and filled out by chief physicians or senior instructors responsible for endoscopic therapies in participating hospitals across 31 provinces (autonomous regions and municipalities) in China. Comparisons of guideline adherence between primary and referral medical centers were performed using the chi‐square test or Fisher's exact test. Results In total, 836 hospitals participated in the survey. For primary and secondary prophylaxis of esophagogastric variceal bleeding (EGVB), adherence to the national guidelines was 72.5% (606/836) and 39.2% (328/836), respectively. Significant differences were observed in the rate of adherence between the primary and referral centers for primary (79.9% [111/139] vs. 71.0% [495/697], p = 0.033) and secondary prophylaxis (27.3% [38/139] vs. 41.6% [290/697], p = 0.002). Of the hospitals, 78.2% (654/836) preferred endoscopic therapies for acute EGVB, and the timing of endoscopy was usually within 12 h (48.5%, 317/654) and 12–24 h (36.9%, 241/654) after bleeding. Endoscopic therapy was more likely to be the first choice of treatment for acute EGVB in referral centers than in primary centers (82.6% [576/697] vs. 56.1% [78/139], p < 0.001). Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, the most prevalent procedures were cyanoacrylate injection combined with sclerotherapy (48.2% [403/836] and 29.9% [250/836], respectively); however, substantial hospitals preferred clip‐assisted therapies (12.4% [104/836] and 26.4% [221/836], respectively). Nonselective beta‐blockers were routinely used in 73.4% (614/836) of hospitals during the perioperative period of EGVB management, and propranolol (88.8%, 545/614) and carvedilol (37.5%, 230/614) were the most widely used nonselective beta‐blockers. Conclusions This survey clarified that various endoscopic procedures have been implemented nationwide in China. Participating hospitals have actively performed emergent endoscopy for acute EGVB; however, these hospitals do not adequately follow recommendations regarding primary and secondary prophylaxis of EGVB. In the future, standardizing the selection of endoscopic procedures and improving compliance with guidelines is crucial.

Portal hypertension & cirrhosisVol. 3(3)
Hebei Medical University (CN), Central South University (CN), Nanchang University (CN), Guiyang Medical University (CN), Army Medical University (CN), Xinjiang Medical University (CN), Harbin Medical University (CN), Sun Yat-sen University (CN), Shanxi Medical University (CN), Jilin University (CN), Anhui Medical University (CN), Sichuan University (CN), Fudan University (CN), Kunming Medical University (CN), First Affiliated Hospital of Xinjiang Medical University (CN), Tianjin Third Central Hospital (CN), West China Hospital of Sichuan University (CN), Daping Hospital (CN), Key Laboratory of Guangdong Province (CN), Second Hospital of Hebei Medical University (CN), Zhongda Hospital Southeast University (CN), Affiliated Hospital of Guizhou Medical University (CN), The People's Hospital of Guangxi Zhuang Autonomous Region (CN), First Affiliated Hospital of Kunming Medical University (CN), Zhongshan Hospital of Xiamen University (CN), First Hospital of Jilin University (CN), Zhongshan Hospital (CN), Ningxia Medical University (CN), The First Affiliated Hospital, Sun Yat-sen University (CN), Second Affiliated Hospital of Xi'an Jiaotong University (CN), Second Affiliated Hospital of Harbin Medical University (CN), Second Hospital of Shanxi Medical University (CN), Tibet Autonomous Region People's Hospital (CN), First Affiliated Hospital of Anhui Medical University (CN), First Hospital of China Medical University (CN), Third Affiliated Hospital of Sun Yat-sen University (CN), Qinghai Provincial Peoples Hospital (CN), Jiangsu Province Hospital (CN), First Affiliated Hospital of Zhengzhou University (CN), Xiangya Hospital Central South University (CN), Tongji Hospital (CN), Baotou Medical College (CN), Qilu Hospital of Shandong University (CN), First Hospital of Lanzhou University (CN), First Affiliated Hospital of Nanchang University (CN), First Affiliated Hospital Zhejiang University (CN), State Key Laboratory of Digital Medical Engineering (CN), Huazhong University of Science and Technology (CN), Tianjin Medical University (CN), Lanzhou University (CN), Hainan Medical University (CN), Nanjing Medical University (CN), China Medical University (CN)
National Natural Science Foundation of China, Natural Science Foundation of Guangdong Province
Good health and well-being
Openalex Percentile: Top 22%
Liver Disease and Transplantation
1.11
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