Risk factors for bleeding complications after endoscopic variceal ligation therapy.
BACKGROUND
Bleeding from esophageal varices is a severe complication of portal hypertension. Endoscopic band ligation (EBL) is the treatment of choice for acute variceal bleeding. It is also performed for primary and secondary prophylaxis of bleeding from esophageal varices. After EBL, patients are at risk of postinterventional bleeding; the risk factors for this complication are poorly evaluated.


METHODS
We retrospectively analyzed data from patients who underwent EBL. We evaluated clinical data, laboratory and endoscopic findings.


RESULTS
255 patients with 387 ligation sessions were included in the analysis. Patients with bleeding complications had a significantly higher severity of liver disease as measured by a higher Child-Pugh score (10.5 vs. 8, p = 0.002), lower albumin (26.5 vs. 31.9 [g/L], p = 0.0001) and lower prothrombin activity (46.5 vs. 70 [%], p = 0.0001). The incidence of bacterial infection was significantly higher in patients with postinterventional bleeding. As well, the white blood cell count was significantly higher in the bleeding group (9.5 vs. 6.5 [× 10 (9) /L], p = 0.030). In patients with bleeding events we observed an elevated heart rate compared to those without this complication (80 vs. 72 [bpm], p = 0.017). Furthermore, we found a lower hemoglobin level (5.9 vs. 6.4 [mmol/L], p = 0.028) and a lower hematocrit (0.280 vs. 0.314, p = 0.031) in the bleeding group. Younger patients suffered more often from postinterventional bleeding (52.5 vs. 58 [years], p = 0.012).


CONCLUSIONS
There are clinical data which can be ascertained easily in order to reflect the risk of bleeding complications after EBL.
Grothaus
J
J
Department of Internal Medicine II, University of Leipzig, Leipzig, Germany. albrecht.hoffmeister@medizin.uni-leipzig.de
Petrasch
F
F
Zeynalova
S
S
Mössner
J
J
Schiefke
I
I
Hoffmeister
A
A
D000328:Adult; D000368:Aged; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D004932:Esophageal and Gastric Varices / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008026:Ligation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors