THE PREDICTORS OF RE-BLEEDING IN CHRONIC LIVER DISEASE PATIENTS AFTER ENDOSCOPIC VARICEAL
Keywords:Key words: Variceal bleed, endoscopic variceal band ligation, rebleeding
AbstractBackground: Variceal bleeding is a key and most fatal complication observed in chronic liver disease patients with portal hypertension and is a major contributor to the high morbidity and mortality seen in these patients. Exploring the predictors of rebleeding in chronic liver disease patients is of paramount importance to alter disease course and impact on morbidity and mortality. Methods: About 50 patients with chronic liver disease who previously had evidence of varices on upper GI endoscopy and had at least one episode of rebleeding after EVBL were included in this study. Patients were assessed for the possible contributors to rebleeding through complete history, clinical examination, coagulation profile and platelet count, ultrasound features (splenic size and portal pressure), and upper GI endoscopic findings (site and grade of varices, red sign). Sample selection was done using non-probability purposive sampling technique and sample size calculated using the standard WHO formula. Data was entered and analyzed using SPSS version 20. Results: In this study, mean age of the patients was 51.34±6.34 years with male predominance (64%). Rebleeding was significantly associated with grade of varices, presence of red sign on upper GI endoscopy, site of varices, splenic size and coagulopathy. Conclusion: Rebleeding in chronic liver disease patients following EVBL is predicted by grade, extent and site of varices, red sign on upper GI endoscopy, splenic size and coagulation disturbances.
Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology 1995;108(6):1828–34.
Bruns T, Zimmermann HW, Stallmach A. Risk factors and outcome of bacterial infections in cirrhosis. World J Gastroenterol 2014;20(10):2542–54.
Bosch J, García-Pagán JC. Prevention of variceal rebleeding. Lancet 2003;361(9361):952–4.
Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM, et al. Predictors of large esophageal varices in patients with cirrhosis. Am J Gastroenterol 1999;94(11):3285–91.
Lo GH, Chen WC, Chen MH, Lin CP, Lo CC, Hsu PI, et al. Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis. Gastrointest Endosc 2004;59(3):333–8.
Ben-Ari Z, Cardin F, McCormick AP, Wannamethee G, Burroughs AK. A predictive model for failure to control bleeding during acute variceal haemorrhage. J Hepatol 1999;31(3):443–50.
D'Amico G, De Franchis R. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003;38(3):599–612.
D'Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Baillieres Clin Gastroenterol 1997;11(2):243–56.
Cho H, Nagata N, Shimbo T, Sakurai T, Sekine K, Okubo H, et al. Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long-term cohort study. Hepatol Res 2016;46(13):1338–46.
Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 2003;98(3):653–9.
Bañares R, Albillos A, Rincón D, Alonso S, González M, Ruiz-del-Arbol L, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002;35(3):609–15.
Lo GH, Lai KH, Ng WW, Tam TN, Lee SD, Tsai YT, et al. Injection sclerotherapy preceded by esophageal tamponade versus immediate sclerotherapy in arresting active variceal bleeding: a prospective randomized trial. Gastrointest Endosc 1992;38(4):421–424.
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46(3):922–38.
García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010;362(25):2370–9.
Escorsell À, Bosch J. Self-expandable metal stents in the treatment of acute esophageal variceal bleeding. Gastroenterol Res Pract 2011;2011:910986.
Avgerinos A, Armonis A. Balloon tamponade technique and efficacy in variceal haemorrhage. Scand J Gastroenterol 1994;29(207):11–6.
D'Amico M, Berzigotti A, Garcia-Pagan JC. Refractory acute variceal bleeding: what to do next? Clin Liver Dis 2010;14(2):297–305.
D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: A meta-analytic review. Hepatology 1995;22(1):332–54.
Ugiagbe RA, Omuemu CE. Etiology of upper gastrointestinal bleeding in the University of Benin Teaching Hospital, South-Southern Nigeria. Niger J Surg Sci 2016;26(2):29–32.
Vanbiervliet G, Giudicelli-Bornard S, Piche T, Berthier F, Gelsi E, Filippi J, et al. Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study. Aliment Pharmacol Ther 2010;32(2):225–32.
Van Vlierberghe H, De Vos M, Hautekeete M, Elewaut A. Severe bleeding following endoscopic variceal ligation: should EVL be avoided in Child C patients? Acta Gastroenterol Belg 1999;62(2):175–7.
Lee SW, Lee TY, Chang CS. Independent factors associated with recurrent bleeding in cirrhotic patients with esophageal variceal hemorrhage. Dig Dis Sci. 2009;54(5):1128–34.
Hou MC, Lin HC, Lee FY, Chang FY, Lee SD. Recurrence of esophageal varices following endoscopic treatment and its impact on rebleeding: comparison of sclerotherapy and ligation. J Hepatol 2000;32(2):202–8.
Hou MC, Lin HC, Kuo BI, Lee FY, Chang FY, Lee SD. The rebleeding course and long-term outcome of esophageal variceal hemorrhage after ligation: comparison with sclerotherapy. Scand J Gastroenterol 1999;34(11):1071–6.
Krige JE, Kotze UK, Distiller G, Shaw JM, Bornman PC. Predictive factors for rebleeding and death in alcoholic cirrhotic patients with acute variceal bleeding: a multivariate analysis. World J Surg 2009;33:2127–35.
Vieira da Rocha EC, D’Amico EA, Caldwell SH, Flores da Rocha TR, Soares E Silva CS, Dos Santos Bomfim V, et al. A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation. Clin Gastroenterol Hepatol 2009;7(9):988–93.
Kayacetin E, Efe D, Doğan C. Portal and splenic hemodynamics in cirrhotic patients: relationship between esophageal variceal bleeding and the severity of hepatic failure. J Gastroenterol 2004;39(7):661–7.
Kim HY, Jin EH, Kim W, Lee JY, Woo H, Oh S, et al. The Role of Spleen Stiffness in Determining the Severity and Bleeding Risk of Esophageal Varices in Cirrhotic Patients. Medicine (Baltimore) 2015;94(24):e1031.
Li L, Duan M, Chen W, Jiang A, Li X, Yang J, et al. The spleen in liver cirrhosis: revisiting an old enemy with novel targets. J Transl Med 2017;15(1):111.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.