{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T02:00:04Z","timestamp":1767837604563,"version":"3.49.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:00:00Z","timestamp":1647302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Abbie GK"},{"name":"Aska Pharmaceuticals Co.,Ltd."},{"DOI":"10.13039\/100015731","name":"Bayer Yakuhin Ltd.","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015731","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002975","name":"Dainippon Sumitomo Pharma","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002975","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014421","name":"EA Pharma Co., Ltd.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014421","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003769","name":"Eisai","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003769","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008897","name":"Janssen Pharmaceuticals","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008897","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012781","name":"MSD K.K.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012781","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007132","name":"Otsuka Pharmaceutical","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007132","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Toray Medical Co."}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Aim<\/jats:title><jats:p>To establish a therapeutic strategy for cirrhosis patients with gastric variceal bleeding.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>The outcomes of 137 patients with bleeding gastric varices were evaluated.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The bleeding source was gastroesophageal varices (GOV) in 86 patients, and gastric fundal varices (FV) in 51 patients. The Child-Turcotte-Pugh classes were A, B, and C in 26, 79, and 32 patients, respectively; 34 patients (24.8%) had hepatocellular carcinoma (HCC), of which 11 also had complicating portal venous tumor thrombosis (PVTT). Patients with GOV were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with FV were treated by EIS with cyanoacrylate; 29 patients with FV also underwent additional balloon-occluded retrograde transvenous obliteration (BRTO). Hemostasis was successfully achieved in 136 patients (99.3%), and the cumulative 1-year, 3-year, and 5-year rebleeding rates were 18.1%, 30.8%, and 30.8%, respectively, in the patients with GOV, and 2.2%, 12.5% and 12.5%, respectively, in the patients with FV. The overall 1-year, 3-year, and 5-year survival rates were 79.7%, 71.5% and 64.4%, respectively, in the patients with GOV, and 91.0%, 76.9% and 59.5%, respectively, in the patients with FV. Multivariable analysis identified PVTT and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Endoscopic therapies with or without BRTO appeared to be useful therapeutic strategies to prevent rebleeding in patients with gastric variceal bleeding, and favorable outcomes were obtained, except in patients with underlying HCC associated with PVTT and\/or severe liver damage.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0264359","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T17:29:06Z","timestamp":1647365346000},"page":"e0264359","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices"],"prefix":"10.1371","volume":"17","author":[{"given":"Manabu","family":"Nakazawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukinori","family":"Imai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayoko","family":"Sugawara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihito","family":"Uchida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoichi","family":"Saitoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohei","family":"Fujii","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Uchiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satsuki","family":"Ando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuaki","family":"Nakayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoaki","family":"Tomiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8792-4526","authenticated-orcid":true,"given":"Satoshi","family":"Mochida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,3,15]]},"reference":[{"key":"pone.0264359.ref001","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","article-title":"EASL clinical practice guidelines for the management of patients with decompensated cirrhosis","volume":"69","author":"European Association for the Study of the Liver","year":"2018","journal-title":"J Hepatol"},{"key":"pone.0264359.ref002","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1002\/hep.20339","article-title":"Improved survival after variceal bleeding in patients with cirrhosis over the past two decades","volume":"40","author":"N Carbonell","year":"2004","journal-title":"Hepatology"},{"key":"pone.0264359.ref003","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/hepr.12357","article-title":"Variceal hemorrhage: Analysis of 9,987 cases from a Japanese nationwide database","volume":"45","author":"M Sato","year":"2015","journal-title":"Hepatol Res"},{"key":"pone.0264359.ref004","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases","volume":"65","author":"G Garcia-Tsao","year":"2017","journal-title":"Hepatology"},{"key":"pone.0264359.ref005","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1002\/hep.1840160607","article-title":"Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients","volume":"16","author":"SK Sarin","year":"1992","journal-title":"Hepatology"},{"key":"pone.0264359.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1443-1661.2009.00929.x","article-title":"General rules for recording endoscopic findings of esophagogastric varices (2nd edition)","volume":"22","author":"T Tajiri","year":"2010","journal-title":"Dig Endosc"},{"key":"pone.0264359.ref007","first-page":"743","article-title":"Expanding consensus in portal hypertension. 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