title: Emergency endoscopic variceal ligation in cirrhotic patients with blood clots in the stomach but no active bleeding or stigmata increases the risk of rebleeding.
abstract: OBJECTIVE
  This study aimed to evaluate the efficacy and safety of emergency variceal ligation for the prevention of rebleeding in cirrhotic patients who are found on initial endoscopy to have blood clots in the stomach but no actively bleeding esophageal and gastric varices or stigmata.
  
  
  METHODS
  This study included 28 cirrhotic patients who underwent emergency prophylactic EVL and 41 who underwent an elective intervention between January 2009 and June 2014. Clinical outcomes were analyzed, including the rebleeding, 6-week mortality, and rebleeding-free survival rates.
  
  
  RESULTS
  The rebleeding rate was higher in the emergency than in the elective group (28.6% vs. 7.3%,P=0.041). Multivariate analysis showed that emergency prophylactic EVL (odds ratio [OR] = 7.4, 95% confidence interval [CI]=1.634.8,P=0.012) and Child-Pugh score C (OR=10.6, 95% CI=1.4-80.8,P=0.022) were associated with rebleeding. In the emergency group, the gastric varices were associated with rebleeding (OR=12.0, 95% CI=1.7-83.5,P=0.012).
  
  
  CONCLUSIONS
  Emergency EVL may be associated with variceal rebleeding when blood clots are present in the stomach without active esophageal and gastric variceal bleeding or stigmata. Elective intervention should be considered as a safer strategy for preventing variceal rebleeding in this situation.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Nam
authors.affiliation: Gene & Cell Therapy Research Center for Vessel-associated Diseases, Yangsan, Korea.
authors.forename: Sm Bakhtiar Ui
authors.initials: SB
authors.lastname: Islam
mesh_terms: D000368:Aged; D004632:Emergency Medical Services; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013270:Stomach / Q000473:pathology; D015996:Survival Rate; D013927:Thrombosis
keywords: Bleeding; Esophageal and Gastric Varices; Liver Cirrhosis