The Timing of Emergency Endoscopy for Esophagogastric Variceal Bleeding in Cirrhosis

NCT ID: NCT04932200

Last Updated: 2021-06-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

608 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-06-15

Study Completion Date

2022-04-30

Brief Summary

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This study is a prospective, multi-center and observational clinical study. Investigators would like to explore the optimal emergency endoscopy timing in cirrhosis patients with esophagogastric variceal bleeding (EGVB) by evaluating and comparing the efficacy and safety of emergency endoscopy performed at different times ( within 6 hours or between 6 and 24 hours after gastroenterologic consultation ) and its impact on the short-term prognosis.

Detailed Description

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Between July 2021 and April 2022, patients with cirrhosis undergoing emergency endoscopy due to EGVB are enrolled consecutively according to the following criteria: (1) age≥18 years; (2) A definite diagnosis of cirrhosis (confirmed by medical history, laboratory examination and imaging examination); (3) The cause of bleeding was identified as esophageal and/or gastric vein rupture. Exclusion criteria are as follows: (1) End-stage diseases of major organs (such as heart failure, chronic obstructive pulmonary disease, end-stage renal disease, and malignancies other than hepatocellular carcinoma); (2) The subject (or legal representative/guardian) refused to sign the informed consent.

Patients were divided into urgent-endoscopy group (\< 6h) and early-endoscopy group (6h-24h) according to the time interval from gastroenterologic consultation to the start of emergency endoscopy.

Investigators will collect patients' data of baseline character, treatment, postoperative and follow-up. All patients will be followed up until death or the end of the study.

Conditions

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Liver Cirrhosis Portal Hypertension Esophageal Varix Bleeding

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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urgent-endoscopy group

the time interval from gastroenterologic consultation to the start of emergency endoscopy \< 6 hours

No interventions assigned to this group

early-endoscopy group

the time interval from gastroenterologic consultation to the start of emergency endoscopy between 6 and 24 hours

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* age≥18 years
* A definite diagnosis of cirrhosis (confirmed by medical history, laboratory examination and imaging examination)
* The cause of bleeding was identified as esophageal and/or gastric vein rupture

Exclusion Criteria

* End-stage diseases of major organs (such as heart failure, chronic obstructive pulmonary disease, end-stage renal disease, and malignancies other than hepatocellular carcinoma)
* The subject (or legal representative/guardian) refused to sign the informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Beijing Friendship Hospital

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Nanchang University

OTHER

Sponsor Role collaborator

Fudan University

OTHER

Sponsor Role collaborator

Southwest Hospital, China

OTHER

Sponsor Role collaborator

Beijing Shijitan Hospital, Capital Medical University

OTHER

Sponsor Role collaborator

Fuyang NO.2 Renmin Hospital

UNKNOWN

Sponsor Role collaborator

Hubei Hospital of Traditional Chinese Medicine

OTHER

Sponsor Role collaborator

Wuhan No.1 Hospital

OTHER

Sponsor Role collaborator

Wuhan Puren Hospital

OTHER

Sponsor Role collaborator

Tianyou Hospital Affiliated to Wuhan University of Science and Technology

OTHER

Sponsor Role collaborator

The Central Hospital of Enshi Tujia And Miao Autonomous Prefecture

OTHER

Sponsor Role collaborator

Yichang Central People's Hospital

OTHER

Sponsor Role collaborator

Shiyan Renmin Hospital

UNKNOWN

Sponsor Role collaborator

Hanyang University

OTHER

Sponsor Role collaborator

The Third People's Hospital of Hubei Province

OTHER

Sponsor Role collaborator

Chibi Renmin Hospital

UNKNOWN

Sponsor Role collaborator

Renmin Hospital of Wuhan University

OTHER

Sponsor Role lead

Responsible Party

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ChenMingkai

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mingkai Chen, PHD

Role: PRINCIPAL_INVESTIGATOR

Renmin Hospital of Wuhan University

Locations

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Renmin Hospital of Wuhan University

Wuhan, Hubei, China

Site Status

Countries

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China

Central Contacts

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Mingkai Chen, PHD

Role: CONTACT

+86 13720330580

References

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Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017 Jan;65(1):310-335. doi: 10.1002/hep.28906. Epub 2016 Dec 1. No abstract available.

Reference Type BACKGROUND
PMID: 27786365 (View on PubMed)

Tripathi D, Stanley AJ, Hayes PC, Patch D, Millson C, Mehrzad H, Austin A, Ferguson JW, Olliff SP, Hudson M, Christie JM; Clinical Services and Standards Committee of the British Society of Gastroenterology. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015 Nov;64(11):1680-704. doi: 10.1136/gutjnl-2015-309262. Epub 2015 Apr 17.

Reference Type BACKGROUND
PMID: 25887380 (View on PubMed)

Reiberger T, Puspok A, Schoder M, Baumann-Durchschein F, Bucsics T, Datz C, Dolak W, Ferlitsch A, Finkenstedt A, Graziadei I, Hametner S, Karnel F, Krones E, Maieron A, Mandorfer M, Peck-Radosavljevic M, Rainer F, Schwabl P, Stadlbauer V, Stauber R, Tilg H, Trauner M, Zoller H, Schofl R, Fickert P. Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III). Wien Klin Wochenschr. 2017 Nov;129(Suppl 3):135-158. doi: 10.1007/s00508-017-1262-3. Epub 2017 Oct 23.

Reference Type BACKGROUND
PMID: 29063233 (View on PubMed)

de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015 Sep;63(3):743-52. doi: 10.1016/j.jhep.2015.05.022. Epub 2015 Jun 3. No abstract available.

Reference Type BACKGROUND
PMID: 26047908 (View on PubMed)

European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-460. doi: 10.1016/j.jhep.2018.03.024. Epub 2018 Apr 10. No abstract available.

Reference Type BACKGROUND
PMID: 29653741 (View on PubMed)

Cheung J, Soo I, Bastiampillai R, Zhu Q, Ma M. Urgent vs. non-urgent endoscopy in stable acute variceal bleeding. Am J Gastroenterol. 2009 May;104(5):1125-9. doi: 10.1038/ajg.2009.78. Epub 2009 Mar 31.

Reference Type BACKGROUND
PMID: 19337243 (View on PubMed)

Hsu YC, Chung CS, Tseng CH, Lin TL, Liou JM, Wu MS, Hu FC, Wang HP. Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage. J Gastroenterol Hepatol. 2009 Jul;24(7):1294-9. doi: 10.1111/j.1440-1746.2009.05903.x.

Reference Type BACKGROUND
PMID: 19682197 (View on PubMed)

Chen PH, Chen WC, Hou MC, Liu TT, Chang CJ, Liao WC, Su CW, Wang HM, Lin HC, Lee FY, Lee SD. Delayed endoscopy increases re-bleeding and mortality in patients with hematemesis and active esophageal variceal bleeding: a cohort study. J Hepatol. 2012 Dec;57(6):1207-13. doi: 10.1016/j.jhep.2012.07.038. Epub 2012 Aug 8.

Reference Type BACKGROUND
PMID: 22885718 (View on PubMed)

Jung DH, Huh CW, Kim NJ, Kim BW. Optimal endoscopy timing in patients with acute variceal bleeding: A systematic review and meta-analysis. Sci Rep. 2020 Mar 4;10(1):4046. doi: 10.1038/s41598-020-60866-x.

Reference Type BACKGROUND
PMID: 32132589 (View on PubMed)

Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, Luk SWY, Wong SH, Lau LHS, Lui RN, Chan TT, Mak JWY, Chan FKL, Sung JJY. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2020 Apr 2;382(14):1299-1308. doi: 10.1056/NEJMoa1912484.

Reference Type BACKGROUND
PMID: 32242355 (View on PubMed)

Huh CW, Kim JS, Jung DH, Yang JD, Nam SW, Kwon JH, Kim BW. Optimal endoscopy timing according to the severity of underlying liver disease in patients with acute variceal bleeding. Dig Liver Dis. 2019 Jul;51(7):993-998. doi: 10.1016/j.dld.2019.01.013. Epub 2019 Jan 29.

Reference Type BACKGROUND
PMID: 30803858 (View on PubMed)

Other Identifiers

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WDRY2021-K061

Identifier Type: -

Identifier Source: org_study_id

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