Long-Term Outcomes After Endoscopic Sequential Therapy in Patients With Gastroesophageal Variceal Bleeding as the First Decompensated Event

INTRODUCTION: Limited data exist regarding the portal hypertension progression in cirrhotic patients with variceal bleeding as the initial decompensation event. This study evaluated the impact of sequential endoscopic therapy on long-term clinical outcomes. METHODS: 196 hospitalized cases were included and divided into esophageal varices (EV), type 1 gastroesophageal varices (GOV1), type 2 GOV (GOV2), and type 3 GOV (GOV3) groups. The Fine-Gray test was used to analyze the cumulative incidence of outcome events. Survival was calculated using the Kaplan-Meier method, and the Cox proportional risk regression model was used for multivariate analysis of factors affecting outcomes. RESULTS: During a median follow-up period of 104.9 months, distinct cumulative outcomes were observed across esophageal and gastric variceal subtypes. The 1-, 3-, and 5-year cumulative rebleeding rates progressively increased across subtypes: EV (16.2%, 29.7%, 41.9%), GOV1 (18.8%, 39.6%, 45.8%), GOV2 (19.1%, 34.0%, 46.8%), and GOV3 (44.4%, 63.0%, 66.7%) (Gray test, P = 0.009). Corresponding survival rates demonstrated an inverse pattern, declining with longer follow-up: EV (91.9%, 82.4%, 58.1%), GOV1 (91.7%, 79.2%, 60.4%), GOV2 (91.5%, 76.6%, 55.3%), and GOV3 (74.1%, 55.6%, 48.1%) (log-rank test, P = 0.016). Rebleeding was an independent risk factor associated with survival (hazard ratio: 3.518, P < 0.001). Multivariate analysis showed that variceal shape, variceal type, and the treatment courses to variceal eradication (whether > 3) were significant risk factors for rebleeding ( P < 0.05). DISCUSSION: In this study, rebleeding dominated the clinical course of different subtypes and was an independent predictor of death. More aggressive treatments, such as salvage transjugular intrahepatic portosystemic shunt, should be considered in patients who were at higher risk of rebleeding.