PREDICTIVE FACTORS OF REBLEEDING AFTER THE FIRST ENDOSCOPIC THERAPY OF ESOPHAGEAL VARICEAL HEMORRHAGE

Aims Variceal rebleeding describes bleeding that occurs≥120 hours after the first hemorrhage provided that hemostasis was initially achieved. It is associated with a high rate of mortality.This study aims to determine the independent factors associated with recurrent variceal bleeding in cirrhotic patients.

Methods 70 cirrhotic with esophageal variceal bleeding(EVB) admitted to our hospital between 2018 and December 2021 were retrospectively analyzed.We distinguish between rebleeding and non-rebleeding group.Demographic information,medical histories,and laboratory test results were collected.The multivariate analysis was performed using Cox regression test to identify independent risk factors of rebleeding.Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test.

Results The incidence of rebleeding after EVL was 64%.By univariate regression analysis, the statistically significant predictor for variceal rebleeding was the presence of high stigmata of bleeding on upper endoscopy(p:0,05). Furthermore, we presume that recurrent hemorrhage is associated with a higher incidence of bacterial infection (p:0.006).However, we found that other parameters such as age, gender, etiology, severity of liver disease(ascites,encephalopathy,hepatocellular carcinoma,portal vein thrombosis), severity of EVB(hemoglobin,blood pressure,requirements of blood transfusion), the presence of large varices or the number of endoscopic variceal banding had no significant influence in the risk of rebleeding.The median survival was lower in rebleeding group calculated at 6 years versus 10 years in the non-rebleeding group (p:0,097).

Conclusions This study provides evidence that recurrent hemorrhage is significantly associated with a higher incidence of bacterial infection and stigmata of bleeding on upper endoscopy.We conclude also that there is no significant difference in median survival between bleeding and non-rebleeding groups.

Publication History

Article published online:
14 April 2022