RISK FACTORS FOR PREDICTING EARLY VARICEAL REBLEEDING AFTER ENDOSCOPIC VARICEAL LIGATION (EVL)

Aims:

The aim of this study is to determine the factors predicting the occurrence of post LVO bleeding and its mortality.

Methods:

Between April 2010 and April 2018, 587 LVOs were performed in the gastroenterology endoscopy unit in 393 patients with cirrhotic portal hypertension. Early rebleeding following EVL is mainly due to early spontaneous slippage of rubber bands leaving the unhealed ulcer.

Results:

The complication occurred in 32 patients (8.1%) whose mean age was 49.9, twenty-five patients were admitted through emergency departments for gastrointestinal bleeding while 21.2% were under secondary prevention protocol by ligation. This EGD was performed by a junior doctor at 21 patients with the establishment on average 4.7 rings [2.9]. All our patients received octreotide for an average of 3.8 days, whereas none of them was put under PPIs after the realization of this 1st EGD. The pressure bleeding occurred within an average delay of 7.4 days. It induced haemodynamic instability in 8 patients (25%) requiring transfusion in 78% of patients. univariate analysis, the risk factors for the occurrence of this hemorrhagic event were: ligation in the setting (p = 0.004), the presence of ascites (p = 0.001), the hepatic encephalopathy (p = 0.001), the platelet count < 70 000 (p = 0.04), the presence of a portal hypertensive gastropathy (p = 0.001), an advanced child Pugh score (p = 0.0034) and the achievement of the EGD by a junior (p = 0.004). The multi-varied analysis concluded that only a low platelet count is statistically associated with the occurrence of fall of eschar. Mortality was 31.2% (n = 10) following this complication.

Conclusions:

Early rebleeding following EVL in cirrhotic patients is a serious complication, especially in cases of emergency recruitment. The occurrence of this complication was statistically linked to low platelet count and a high mortality rate.