Risk Factors Of Early Rebleeding In Patients With Gastroesophageal Variceal Hemorrage After Endoscopic

Backgrounds:Esophageal variceal bleeding is a catastrophic complication of portal hypertension, with a high morbidity and mortality. During past decades, endoscopic band ligation (EBL) has been widely used in the treatment of acute bleeding episode, and it is now considered to be the first line treatment of esophageal variceal hemorrhage and bleeding from gastroesophageal varices Type 1 (G0V1). However, rebleeding occurs in about 60%-70% of the survivors, if untreated, within 7-10 days, indicating the importance of early-and-effective secondary prophylaxis. Despite great clinical benefits of EBL in secondary prophylaxis, the rebleeding rate is around 9%-35.8%. It is suggested that repeated ligation be performed at 2-4weekly intervals. Hence rebleeding before the repeated ligation indicates failure of the initial band ligation and requires salvage modalities even before the repeated ligation.It has been recognized that several factors possibly affect the risk of recurrent variceal hemorrhage, including HVPG, active bleeding at emergency endoscopy, low serum albumin levels, size of the varices, red color signs on varices, infection, renal failure, and hepatocellular carcinoma with portal vein thrombosis. However, there has been no predictive model developed that can accurately predict rebleeding risk before the repeated ligation.Aims:In variceal bleeding patients undergoing endoscopic band ligation, early rebleeding risk can be predicted by statistical models, however, no such models has yet been published. Our aims were to study the predictors of early rebleeding after band ligation and establish a predictive model for failure of band ligation in esophageal variceal bleeding patients.MethodsrWe retrospectively studied 265 patients undergoing EBL in 2 medical centers in China, admitted with active bleeding or evidence of recent bleeding from gastroesophageal varices. Each patient had a 2-weeks’ follow-up. Analysis was done by SPSS 19. P<0.05 was considered to be statistically significant. Logistic regression model was the main statistical tool for rebleeding risk modeling.Results:Post-EBL rebleeding rate within 2 weeks is approximately 9.06%(24/265). Multivariate logistic regression identified HVPG, WBC count, blood hemoglobulin concentration and INR, as independent predictors of early rebleeding after EBL. These variables can be used to calculate a post-EBL rebleeding risk score (PERRS) for patients undergoing EBL. Rebleeding is likely to occur in patients with PERRS>0.076 within 2 weeks after the ligation procedure.Conclusion:This model may predict rebleeding risk within 2 weeks after EBL in patients with gastro-esophageal variceal hemorrhage and portal hypertension, and identify patients who might underwent failure of initial EBL, for whom it might be beneficial to turn to salvage modalities in advance.