Upper Gastrointestinal Bleeding in Liver Cirrhosis : clinical and endoscopic findings

Chung, In Sik; Kim, Boo Sung; Lee, Chang Don; Park, Doo Ho; Oh, Soo Hyuk; Kim, Jae Kwang; Han, Sang Won; Kim, Sung Soo; Yoon, Seung Kew; Choi, Myug Gyu

Abstract

It is well known that the main source of upper gastrointestinal(UGI) bleeding in patients with liver cirrhosis is the variceal rupture of esophagus. But, peptic ulcer disease, congestive gastrophathy, and gastric varices are frequently found by endoscopic examination in patients with liver cirrhosis. These lesions are related to UGI bleeding. It is necessary to verify the causes of bleeding in liver cirrhosis, and evaluate the influencing factors related with UGI bleeding, and define the endoscopic findings of bleeding in liver cirrhosis. We reviewed the records of 145 episodes of UGI bleeding in cirrhosis, with endoscopy performed within 24 hours of entry, and report here the bleeding sites, influencing factors related with UGI bleeding, and endoscopic findings. The most common bleeding site was the esophageal varices(66.9%). Other bleeding lesions included gastric ulcer(8.3%), congestive gastrophathy(6.9%), undetermined origin(6.9%), duodenal ulcer(6.2%), gastric varices(2.1%), esophageal varices+gastric ulcer(1.4%), and esophageal varices+duodenal ulcer(1.4%). Endoscopic features of bleeding esophageal varices were identified as Spurting(2.1%), Oozing(11.3%), Red plugh(10,3 %), White plugh(14.4%), and Red-color sign(61.9%). In bleeding esophageal varices, gradeIV varices(41.2%) had a significantly higher association with bleeding than gradeI varices(2.1%), gradeII varices(22.7%), and gradeIII varices(34.0%). Endoscopic features of bleeding gastric ulcer were identified as Spurting(8.3%), Oozing(25.0%), Blood clots(58.3%), and Exposed blood vessels on ulcer base(41.7%). Endoscopic features of bleeding duodenal ulcer were identified as Oozing(44.4%), Blood clots(55.6 %), and Exposed blood vessels on ulcer base(55.6%). We found no difference in the bleeding sources according to etiology of cirrhosis(P>0.05). Bleedings due to the variceal rupture of esophagus were more frequently found in Child class B(71.2%) and C(75.0%) than A(34.8%)(P<0.05).