SELF-EXPANDABLE METALLIC STENTS (SEMS) IN ESOPHAGEAL VARICES POST BAND ULCER REFRACTORY BLEEDING, A RETROSPECTIVE STUDY

Aims:

Evaluate efficacy of SEMS in control of variceal post band ulcer bleeding and 42 days survival outcome.

Methods:

A retrospective study conducted on 28 patients at (Hepatology and gastroenterology department) National Liver Institute, Menofia university, Egypt whom received SEMS as a management of their refractory bleeding from post variceal band ligation ulcer. Patients followed up for 42 days.

Results:

Patients age (mean ± SD) (57.8 ± 8.6) years and 24 were males. Their child class (A/B/C) 3/15/10 respectively with 5 patients had early stage HCC. Admission prognostic scores were MELD (15.7 ± 6.3) MELD Na (20 ± 6.4) ALBI score (-1.36 ± 0.58) and CLIF-C AD (57.96 ± 10.21) (mean ± SD). Their hospital stay range were (1 – 33) days.

As regard control of bleeding, 3 patients had uncontrolled bleeding and 2 patients experienced re-bleeding after initial control and well control of bleeding achieved in 23 (82.1%) patients.7 (25%) patients died, (4 from bleeding, 1 from multiple organ failure MOF & 2 from sepsis). 6 (21.4%) stents were displayed. We classified post banding ulcer endoscopically into A- ulcer covered with clot (9 patients). B- ulcer oozing blood (7 patients). C- ulcer with active spurting (12 patients). Univariate analysis was conducted revealed that post band ulcers other than type A, development of overt hepatic encephalopathy were risk for 42 days mortality (p = 0.04, 0.02 respectively).low base line arterial blood pressure mean 65 ± 6.7 (p = 0.003), increased number of transfused blood units 5.4 ± 4.8 (p = 0.006) and high base line CLIF-C AD score mean 64.4 ± 15.6 (p = 0.05) were associated with 42 days mortality.mean survival 34 (CI 95% 28 – 39) days.

Conclusions:

SEMS is a promising maneuver to control post band ulcer bleeding but individualized approach in respect of type of the ulcer is advised for better survival outcomes.