PREDICTORS OF RE-BLEEDING AFTER OESOPHAGEAL VARICEAL BANDING IN CIRRHOTIC PATIENTS AT 4 WEEKS

Authors

  • Shoaib Asghar Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan
  • Junaid Mustafa Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan
  • Habib ur Rehman Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan
  • Muhammad Kamran Farooq Department of Gastroenterology, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan
  • Muhammad Umar Waheed Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan
  • Salman Shahid Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan

DOI:

https://doi.org/10.55519/JAMC-01-10722

Abstract

Background: Acute upper gastrointestinal bleeding is a serious complication in cirrhotic patients. Without recommended management, recurrent bleeding happens in 30–40% within the next 2–3 days, and up to 60% within 1 week. Aim was to determine predictors of re-bleeding after oesophageal variceal banding in cirrhotic patients for 4 weeks. It was a descriptive study, conducted at the Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Six months from June 21 to December 21, 2021. Methods: A total of 93 patients with active oesophageal variceal bleeding were included in this study. Upper gastrointestinal (UGI) endoscopy was performed to look for bendable varices (grades 1–4) and band ligation was applied. Patients were followed for 4 weeks for the history of hematemesis or Malena, fall in haemoglobin of 2 grams per decilitre or more and endoscopic rebleeding findings. Results: Out of 93 patients, 67(72.0%) were males, while 26(28.0%) were females. The Mean age of the patients was 45.66±16.61 years. According to Child-Pugh Classification, the majority of the patients 45(48.4%) had Child-Pugh Class-A, while 33 (35.5%) were Child B and 15 (16.1%) patients belonged to Child-Pugh Class C. Red wale sign was noted in 22 patients (23.7%). Among 93 cirrhotic patients who presented with variceal bleeding, 9 (9.7%) had re-bleeding within 4 weeks. Amongst 9 patients, 8 patients (88.9%) had red wale sign, grade II or above oesophageal varices and belonged to severe liver disease with child class B or C. Conclusion: Endoscopic variceal band Ligation is an effective treatment modality for the control of oesophageal variceal bleeding. Re-bleeding after band ligation was 9.7%. The major contributing factors to re-bleeding were the severity of cirrhosis, grades and columns of oesophageal varices, number of bands ligation and findings of red wale sign. Increasing age and duration of cirrhosis were contributing predictors of increased re-bleeding risk

Author Biographies

Shoaib Asghar, Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan

 

Junaid Mustafa, Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan

 

Habib ur Rehman, Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan

 

Muhammad Kamran Farooq, Department of Gastroenterology, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan

 

Muhammad Umar Waheed, Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan

 

Salman Shahid, Department of Medicine, Sheikh Zayed Medical College/ Hospital (SZMC/H), Rahim Yar Khan

 

References

Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol 2019;70(1):151–71.

Almani SA, Memon AS, Memon AI, Shah I, Rahpoto Q, Solangi R. Cirrhosis of liver: Etiological factors, complications and prognosis. J Liaquat Uni Med Health Sci 2008;7(2):61–6.

Simonetto DA, Liu M, Kamath PS. Portal hypertension and related complications: diagnosis and management. Mayo Clin Proc 2019;94(4):714–26.

Augustin S, González A, Genescà J. Acute esophageal variceal bleeding: Current strategies and new perspectives. World J Hepatol 2010;2(7):261–74.

Biecker E. Portal hypertension and gastrointestinal bleeding: diagnosis, prevention and management. World J Gastroenterol 2013;19(31):5035–50.

Abbasi A, Bhutto AR, Bhatti KI, Mahmood K, Lal K. Outcome of band ligation in oesophageal varices. J Pak Med Assoc 2013;63(8):983–7.

Belbase NP, Jalan A, Upadhya HP, Mishra R, Karki M, Kumar S. Endoscopic Band Ligation in Patients with Variceal Bleeding. Birat J Health Sci 2018;3(1):320–4.

Zhou JN, Wei Z, Sun ZQ. Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis. Zhonghua Gan Zang Bing Za Zhi 2016;24(7):486–92.

Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan JK. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol 2010;16(1):38–42.

Xavier RG, Tahir MH, Zulkifli MH, Han WH, Hassan A. The use of propranolol as primary prophylaxis in preventing an index bleed in patients with liver cirrhosis: a retrospective cohort study. Dig Med Res 2019;2:33.

D'amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta‐analytic review. Hepatology 1995;22(1):332–54.

Grace ND. Diagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American college of gastroenterology practice parameters committee. Am J Gastroenterol 1997;92(7):1081–91.

North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 1988;319(15):983–9.

Seo YS. Prevention and management of gastroesophageal varices. Clin Mol Hepatol 2018;24(1):20–42.

Santos MM, Tolentino LH, Rodrigues RA, Nakao FS, da Silveira Rohr MR, de Paulo GA, et al. Endoscopic treatment of esophageal varices in advanced liver disease patients: band ligation versus cyanoacrylate injection. Eur J Gastroenterol Hepatol 2011;23(1):60–5.

Latif S, Saleem HQ, Akhtar N, Shafique R, Pari A, Naseeb M, et al. Comparison of endoscopic band ligation alone versus propanalol plus endoscopic band ligation for control of rebleeding Oesophageal varices in patients with portal hypertension. J Khyber Coll Dentistry 2021;11(2):32–7.

Jha AK, Goenka MK. Endoscopic Band Ligation for the Hemostasis of Active Esophageal Variceal Hemorrhage: Technique, Tips, and Tricks. J Dig Endosc 2019;10(4):219–20.

Shrestha R, Thapa J, Yadav B, Thapa B, Paudel MS. Endoscopic detection and management of esophagogastric varices. Cureus. 2021 Aug 2;13(8).

Harewood GC, Baron TH, Wong Kee Song LM. Factors predicting success of endoscopic variceal ligation for secondary prophylaxis of esophageal variceal bleeding. J Gastroenterol Hepatol 2006;21(1):237–41.

Kuran S, Oğuz D, Parlak E, Asil M, Ciçek B, Kilic M, et al. Secondary prophylaxis of esophageal variceal treatment: Endoscopic sclerotherapy, band ligation and combined therapy--long-term results. Turk J Gastroenterol 2006;17(2):103–9.

Elhawari SA, Moustafa EA, Zaher T, Elsadek HM, Abd-Elazeim MA. Frequency and Risk Factors of Post Banding Ulcer Bleeding Following Endoscopic Variceal Ligation in Patients with Liver Cirrhosis. Afro-Egypt J Infect Endem Dis 2019;9(4):252–9.

Cho E, Jun CH, Cho SB, Park CH, Kim HS, Choi SK, et al. Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies? Medicine (Baltimore) 2017;96(24):e7157.

Nguyen KC, Nguyen TH. Efficacy of endoscopic multi-site band ligation in eradicating esophageal varices. Gastrointest Endosc 2009;69(5):AB222.

Slowik V, Bernardez A, Wasserkrug H, Fischer RT, Daniel JF, Grammatikopoulos T. Use and safety of prophylactic endoscopy from a single center serving urban and rural children with portal hypertension. Sci Rep 2022;12(1):25.

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Published

2023-01-15