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CN 22-1108/R
Volume 42 Issue 2
Feb.  2026
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Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(2): 356-361

Safety of endoscopic variceal ligation and endoscopic cyanoacrylate injection in treatment of esophagogastric varices in patients with liver cirrhosis and influencing factors for postoperative bleeding

DOI: 10.12449/JCH260215
  • 1.

    Department of Gastroenterology，Guangzhou Eighth People’s Hospital，Guangzhou Medical University，Guangzhou 510440，China

  • 2.

    Department of Severe Liver Disease，Guangzhou Eighth People’s Hospital，Guangzhou Medical University，Guangzhou 510440，China

  • 3.

    Department of Neurology，Guangzhou Eighth People’s Hospital，Guangzhou Medical University，Guangzhou 510440，China

Research funding:

Medical Research Foundation of Guangdong Province (A2022491)

More Information
  • Corresponding author: HUANG Chunming， gz8hhcm@163.com （ORCID： 0009-0009-9272-5802）
  • Received Date: 2025-08-17
  • Accepted Date: 2025-11-24
  • Published Date: 2026-02-25
    Abstract
  •   Objective  To investigate the risk factors for bleeding within 5 days and 2 weeks after endoscopic variceal ligation （EVL） or endoscopic cyanoacrylate injection （ECI） for the treatment of esophagogastric varices in patients with liver cirrhosis， as well as the safety of EVL/ECI in patients with thrombocytopenia.  Methods  A total of 489 patients with liver cirrhosis and esophagogastric varices who underwent EVL/ECI in Guangzhou Eighth People’s Hospital， Guangzhou Medical University， from January 2018 to December 2023 were enrolled as subjects， and according to the presence or absence of bleeding after surgery， they were divided into bleeding group and non-bleeding group. The risk factors for bleeding within 5 days and 2 weeks after surgery were analyzed. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between groups， and the chi-square test or the continuity-corrected chi-square test was used for comparison of categorical data between groups； the receiver operating characteristic （ROC） curve was plotted to determine the cut-off value of MELD score； a multivariate logistic regression analysis was used to identify the independent risk factors for postoperative bleeding.  Results  There were no significant differences in the bleeding rates within 5 days and 2 weeks after EVL/ECI between the 386 patients with a platelet count of ≥50×109/L and the 103 patients with a platelet count of （25 — 49）×109/L （5 days： 1.94% vs 2.85%， P=0.870； 2 weeks： 2.91% vs 4.92%， P=0.544）. The overall bleeding rate was 2.66% （13/489） and 4.50% （22/489）， respectively， within 5 days and 2 weeks after EVL/ECI. The multivariate logistic regression analysis showed that MELD score was an independent risk factor for bleeding within 5 days （odds ratio ［OR］=3.726， 95% confidence interval ［CI］： 1.214 — 11.429， P=0.021） and 2 weeks （OR=5.760， 95%CI： 1.779 — 18.651， P=0.003） after EVL/ECI， while hemoglobin （Hb） was a protective factor against bleeding within 5 days （OR=0.972， 95%CI： 0.948 — 0.996， P=0.025） and 2 weeks （OR=0.976， 95%CI： 0.957 — 0.995， P=0.016） after surgery； portal vein tumor thrombus （OR=2.667， 95%CI： 1.000 — 7.117， P=0.050） was an independent risk factor for bleeding within 2 weeks after surgery， while platelet count ［（25 — 49）×10⁹/L］ was not a risk factor for postoperative bleeding （P>0.05）.  Conclusion  Both EVL and ECI have good safety in patients with liver diseases and grade 3 thrombocytopenia. MELD score is an independent risk factor for bleeding within 5 days and 2 weeks after EVL/ECI， while Hb is a protective factor； portal vein tumor thrombus is an independent risk factor for bleeding within 2 weeks after surgery.

     

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