Endoscopic treatment of gastroesophageal variceal bleeding after oxaliplatin-based chemotherapy in patients with colorectal cancer

Xiaoquan Huang; Feng Li; Lifen Wang; Mei Xiao; Liyuan Ni; Siyu Jiang; Yuan Ji; Chunqing Zhang; Wei Zhang; Jian Wang; Shiyao Chen

doi:10.1055/a-1157-8611

Endoscopy, Inhaltsverzeichnis

Endoscopy 2020; 52(09): 727-735
DOI: 10.1055/a-1157-8611

Original article

Endoscopic treatment of gastroesophageal variceal bleeding after oxaliplatin-based chemotherapy in patients with colorectal cancer

Xiaoquan Huang‡^*

¹Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

²Center of Evidence-Based Medicine, Fudan University, Shanghai, P.R. China

,

Feng Li‡^*

¹Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

,

Lifen Wang

³Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, P.R. China

,

Mei Xiao

⁴Department of Gastroenterology, Anhui Provincial Hospital, Hefei, Anhui, P.R. China

,

Liyuan Ni

¹Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

,

Siyu Jiang

¹Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

,

Yuan Ji

⁵Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

,

Chunqing Zhang

³Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, P.R. China

,

Wei Zhang

⁶Department of Biostatistics, School of Public Health, Fudan University, Shanghai, P.R. China

,

Jian Wang

¹Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

,

Shiyao Chen

¹Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

²Center of Evidence-Based Medicine, Fudan University, Shanghai, P.R. China

› Institutsangaben

Abstract

Background Oxaliplatin, used as first-choice treatment for colorectal cancer (CRC), induces sinusoidal endothelial injury and portal hypertension. This study investigated the characteristics of oxaliplatin-induced portal hypertension and evaluated the efficacy of endoscopic management of gastroesophageal variceal bleeding.

Methods We performed a retrospective, multicenter, case-control study between January 2010 and December 2018. Patients who received oxaliplatin-based chemotherapy after CRC surgery and presented with portal hypertension and gastroesophageal varices were compared with consecutive patients with hepatitis B-related cirrhotic portal hypertension receiving endoscopic treatment for variceal bleeding.

Results 39 patients with oxaliplatin-induced portal hypertension were identified, 35 of whom had a history of variceal bleeding. The median period between start of oxaliplatin-based chemotherapy and the occurrence of varices was 50.4 months (n = 39). A total of 26 patients with oxaliplatin-related portal hypertension and 230 patients with hepatitis B-related portal hypertension underwent endoscopic treatment. Kaplan-Meier analysis revealed that the 1-year rebleeding rate was significantly higher in the oxaliplatin group than in the hepatitis B group (43.3 % vs. 19.0 %, P = 0.001). Multivariable Cox regression analysis showed that oxaliplatin-based chemotherapy was an independent factor for 3-year rebleeding (hazard ratio [HR] 2.46, 95 % confidence interval [CI] 1.24–4.87; P = 0.01) and 3-year overall mortality (HR 9.43, 95 %CI 2.32–38.31; P = 0.002).

Conclusions Oxaliplatin-related portal hypertension was characterized by massive ascites, splenomegaly, gastric varices, concomitant arterioportal fistula, and relatively normal liver function. Endoscopic treatment to prevent variceal rebleeding in these patients was unsatisfactory compared with endoscopic treatment for hepatitis B-related portal hypertension.

Volltext

Referenzen

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