Amer, K., Jouda, A., Abdel Monem, S. (2016). Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy. Afro-Egyptian Journal of Infectious and Endemic Diseases, 6(1), 48-58. doi: 10.21608/aeji.2016.9629
Kamal Amer; Amal Jouda; Sameh M Abdel Monem. "Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy". Afro-Egyptian Journal of Infectious and Endemic Diseases, 6, 1, 2016, 48-58. doi: 10.21608/aeji.2016.9629
Amer, K., Jouda, A., Abdel Monem, S. (2016). 'Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy', Afro-Egyptian Journal of Infectious and Endemic Diseases, 6(1), pp. 48-58. doi: 10.21608/aeji.2016.9629
Amer, K., Jouda, A., Abdel Monem, S. Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy. Afro-Egyptian Journal of Infectious and Endemic Diseases, 2016; 6(1): 48-58. doi: 10.21608/aeji.2016.9629
Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy
Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
Abstract
Background and study aim : Endoscopic treatment has become the principal first-line intervention in patients with bleeding oesophegeal varices, both during the acute event and for long-term therapy to prevent recurrent bleeding. Several clinical considerations affect the prognosis in individual patients including the severity portal hypertension, the location of the bleeding varices, residual hepatic function, the presence of associated systemic disease, and others. Early rebleeding has been shown to be a strong predictor of mortality and recurrent variceal bleeding substantially increases the risk of complications which further contribute to mortality. This study aimed to evaluate early rebleeding after different methods of endoscopic intervention and investigate the different parameters of the patient that can be correlated to it. Patients and methods: Hundred and four cirrhotic patients with first attack of variceal bleeding were included in this study. They were randomly allocated to two groups, group I: 52 patients who were managed by endoscopic variceal sclerotherapy and group II: 52 patients who were managed by endoscopic variceal band ligation to control their attack. The patients were followed up for six weeks and all their clinical, laboratory, endoscopic parameters were monitored. The rate of mortality and early rebleeding was measured and correlated to these different patients' parameters Results: There was no significant difference between the two groups as regards rate of early rebleeding (15.4% in group I vs 9.6% in group II P= 0.374). The rate of early rebleeding was significantly correlated to Child's score (r=+0.136 P=0.014), PT (r=+0.35 P<0.001), INR(r=+0.419 P<0.001), grade of OV (r=+0.233 P=0.001), risky signs (r=+0.179 P=0.001), units of blood received (r=+0.387 P<0.001), amount of ethanolamine oleate (r=+0.329 P=0.017) and number of rubber bands used (r= +0.245 P=0.039). Mortality rates showed also no significant difference during the six weeks of follow up ,(19.2% in group I vs 21% in group II P= 0.647), as well as mortality rates in rebleeding cases (37.5% in group I vs 40% in group II P=0.925). Conclusion: The factors that are strongly correlated to rate of early rebleeding after endoscopic management of OV are severely decompensated liver disease, larger OV size and presence of risky signs, use of more blood units during resuscitation, use of large amount of ethanolamine oleate during sclerotherapy and use of more rubber band during banding. Sclerotherapy and band ligation are comparable to each other in most outcomes especially early rebleeding and mortality.
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