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Emergency endoscopic variceal ligation in cirrhotic patients with blood clots in the stomach but no active bleeding or stigmata increases the risk of rebleeding
- Source :
- Clinical and Molecular Hepatology, Clinical and Molecular Hepatology, Vol 22, Iss 4, Pp 466-476 (2016)
- Publication Year :
- 2016
- Publisher :
- The Korean Association for the Study of the Liver, 2016.
-
Abstract
- Background/aims 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). Conclusion 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.
- Subjects :
- Liver Cirrhosis
Male
medicine.medical_specialty
Emergency Medical Services
Kaplan-Meier Estimate
Esophageal and Gastric Varices
Gastroenterology
Severity of Illness Index
03 medical and health sciences
0302 clinical medicine
Recurrence
Risk Factors
Internal medicine
Severity of illness
Emergency medical services
medicine
Odds Ratio
Humans
Endoscopy, Digestive System
lcsh:RC799-869
Molecular Biology
Survival rate
Aged
Hepatology
medicine.diagnostic_test
business.industry
Stomach
Bleeding
Thrombosis
Odds ratio
Gastric varices
Middle Aged
medicine.disease
Endoscopy
Survival Rate
medicine.anatomical_structure
030220 oncology & carcinogenesis
Multivariate Analysis
030211 gastroenterology & hepatology
lcsh:Diseases of the digestive system. Gastroenterology
Original Article
Female
business
Gastrointestinal Hemorrhage
Subjects
Details
- Language :
- English
- ISSN :
- 2287285X and 22872728
- Volume :
- 22
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Clinical and Molecular Hepatology
- Accession number :
- edsair.doi.dedup.....c10982bc186c7b5fdd2bd621d943afee