Clin Mol Hepatol.  2016 Dec;22(4):466-476. 10.3350/cmh.2016.0063.

Emergency endoscopic variceal ligation in cirrhotic patients with blood clots in the stomach but no active bleeding or stigmata increases the risk of rebleeding

• Kim SJ
• Choi CW
• Kang DH
• Kim HW
• Park SB
• Hong YM
• Yoon KT
• Cho M
• Nam HS
• Islam SB

• KMID: 2373151
• DOI: http://doi.org/10.3350/cmh.2016.0063

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.

Keyword

Esophageal and Gastric Varices; Liver Cirrhosis; Bleeding

MeSH Terms

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