Outcome in decompensated alcoholic cirrhotic patients with acute variceal bleeding.
BACKGROUND
Variceal bleeding (VB) is the leading cause of death in cirrhotic patients with oesophageal varices. We evaluated the efficacy of emergency endoscopic intervention in controlling acute variceal bleeding and preventing rebleeding and death during the index hospital admission in a large cohort of consecutively treated alcoholic cirrhotic patients after a first variceal bleed.


METHODS
From January 1984 to August 2011, 448 alcoholic cirrhotic patients (349 men, 99 women; median age 50 years) with VB underwent endoscopic treatments (556 emergency, 249 elective) during the index hospital admission. Endoscopic control of initial bleeding, variceal rebleeding and survival after the first hospital admission were recorded.


RESULTS
Endoscopic intervention alone controlled VB in 394 patients (87.9%); 54 also required balloon tamponade. Within 24 hours 15 patients rebled; after 24 hours 61 (17%, n=76) rebled; and 93 (20.8%) died in hospital. No Child-Pugh (C-P) grade A patients died, while 16 grade B and 77 grade C patients died. Mortality increased exponentially as the C-P score increased, reaching 80% when the C-P score exceeded 13.


CONCLUSIONS
Despite initial control of variceal haemorrhage, 1 in 6 patients (17%) rebled during the first hospital admission. Survival (79.2%) was influenced by the severity of liver failure, with most deaths occurring in C-P grade C patients.
Department of Surgery, Faculty of Health Sciences, University of Cape Town. Cape Town. jej.krige@uct.ac.za
Jake E J
JE
Krige
Urda K
UK
Kotze
Rauf
R
Sayed
Sean
S
Burmeister
Marc
M
Bernon
Galya
G
Chinnery
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D016009:Chi-Square Distribution; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D017052:Hospital Mortality; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000145:classification / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010359:Patient Readmission; D012008:Recurrence; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult