Rate and Associated Risk Factors of Rebleeding after Endoscopic Variceal Band Ligation

SUCHART WIPASSAKORNWARA WUTH, M.D.*, MANUS OPASOH, R.N.**, KASIRI AMMARANUN, R.N.**, PATHOMPORN JANTHAWANIT, R.N.**

Affiliation : *Department of Surgery, ** Endoscopic Unit, Sawanpracharak Hospital, Nakhon Sawan 60000, Thailand.

AbstractBleeding esophageal varices is associated with a high mortality rate. Despite advances in management, the mortality rate remains at 30-80 per cent. Endoscopic variceal band ligation (EVL) is a new technique designed to manage esophageal varices with the aim of reducing the complica tion rate. Variceal rebleeding which occurs in 6-36 per cent of patients is common during the treat ment period before variceal obliteration is achieved but related factors remain unknown. Thirty-one patients with a history of esophageal variceal bleeding and endoscopically confirmed between February 1999 and February 2001 received regular EVL until variceal disappearance and were reviewed retro spectively. There was no major complication. Rebleeding was documented in 8 patients (25.8%). Portal hypertension-related conditions, such as gastric varices and portal hypertensive gastropathy, were the most common sources of rebleeding. Platelet count and prothrombin time were not found to be closely related to rebleeding (p-value=0.79, 0.08) but Child-Pugh's C patients had a signifi cantly higher rebleeding rate compared with Child-Pugh's B and A respectively (p-value=0.047). Mortality was high in the rebleeding group significantly (p-value=0.006) and exsanguinations were the major cause of death. In conclusion, the authors suggest that long-term follow-up is required.

Keywords : Cirrhosis, Portal Hypertension, Esophageal Varices, Child-Pugh's Classification, Endoscopic Variceal Band Ligation

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