The natural history and prognostic factors in patients with cirrhosis and gastric fundal varices without prior bleeding

Objectives and methods: The prognostic factors have not yet been fully eval uated in patients with cirrhosis and gastric fundal varices (FV). We invest igated the natural history of 145 patients with cirrhosis and FV with no hi story of bleeding. Various possible prognostic factors, which include clini cal, biochemical, and endoscopical variables. were analyzed using Cox's pro portional hazard model. Results: Among the 145 patients with cirrhosis and FV, there were 76 patients in class A. 45 in class B and 24 class C accordi ng to Child's classification. Sixty-five patients had concomitant hepatocel lular carcinoma at the time of enrollment. Seventy deaths and 34 episodes o f the hemorrhage from FV occurred during the mean follow-up period of 26.4 months. The cumulative survival rates at 1, 3, and 5 years were 75, 53 and 34%, respectively. The cause of death was related to gastrointestinal hemor rhage in 18 patients (15 deaths wen related to FV hemorrhage), hepatic fail ure in 22, hepatocellular carcinoma in 22, and other causes in eight patien ts. In patients with small-, medium-, and large-sized FV, the deaths: relat ed to FV hemorrhage were 4, 21 and 54%, respectively. Overall, the death re lated to FV hemorrhage was 21%. A multiple regression analysis using Cox's model showed hemorrhage from FV, the presence of hepatocellular carcinoma a nd poor Child's status were all highly significant prognostic factors. Conc lusion: The natural history of the patients with cirrhosis and FV was adver sely modified by the hemorrhage From FV. concomitant hepatocellular carcino ma and pool hepatic functional reserve. Since the number of deaths related to FV hemorrhage was great in patients with large-sized FV, it is important to identify high-risk large FV and its prophylactic obliteration. Further studies are needed to elucidate the efficacy of prophylactic obliteration o f large-sized FV. (C) 2000 Elsevier Science Ireland Ltd. All rights reserve d.