Emergency endoscopic variceal ligation in cirrhotic patients with blood clots in the stomach but no active bleeding or stigmata increases the risk of rebleeding.
- Author:
Su Jin KIM
1
;
Cheol Woong CHOI
;
Dae Hwan KANG
;
Hyung Wook KIM
;
Su Bum PARK
;
Young Mi HONG
;
Ki Tae YOON
;
Mong CHO
;
Hyung Seok NAM
;
SM Bakhtiar UI ISLAM
Author Information
- Publication Type:Original Article
- Keywords: Esophageal and Gastric Varices; Liver Cirrhosis; Bleeding
- MeSH: Aged; Emergency Medical Services; Endoscopy, Digestive System; Esophageal and Gastric Varices/complications/*diagnosis; Female; Gastrointestinal Hemorrhage/mortality/*prevention & control; Humans; Kaplan-Meier Estimate; Liver Cirrhosis/complications/*diagnosis; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Recurrence; Risk Factors; Severity of Illness Index; Stomach/pathology; Survival Rate; Thrombosis
- From:Clinical and Molecular Hepatology 2016;22(4):466-476
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: This study aimed to evaluate the efficacy and safety of emergency variceal ligation for the prevention of rebleeding in cirrhotic patients who are found on initial endoscopy to have blood clots in the stomach but no actively bleeding esophageal and gastric varices or stigmata. METHODS: This study included 28 cirrhotic patients who underwent emergency prophylactic EVL and 41 who underwent an elective intervention between January 2009 and June 2014. Clinical outcomes were analyzed, including the rebleeding, 6-week mortality, and rebleeding-free survival rates. RESULTS: The rebleeding rate was higher in the emergency than in the elective group (28.6% vs. 7.3%, P=0.041). Multivariate analysis showed that emergency prophylactic EVL (odds ratio [OR] = 7.4, 95% confidence interval [CI]=1.634.8, P=0.012) and Child-Pugh score C (OR=10.6, 95% CI=1.4-80.8, P=0.022) were associated with rebleeding. In the emergency group, the gastric varices were associated with rebleeding (OR=12.0, 95% CI=1.7-83.5, P=0.012). CONCLUSIONS: Emergency EVL may be associated with variceal rebleeding when blood clots are present in the stomach without active esophageal and gastric variceal bleeding or stigmata. Elective intervention should be considered as a safer strategy for preventing variceal rebleeding in this situation.
