Characteristics And Prevention Of The Early Bleeding After Endoscopic Variceal Ligation

Objective: Esophageal varices are the most common complications of liver cirrhosis, its morbidity and mortality is very high. Endoscopic variceal ligation (EVL) can make the blood flow of varices which are bleeding or about to bleeding blocked completely, and it can be an effective treatment and prevention of esophageal variceal bleeding. Nowadays EVL has become the first line therapy for treatment and prevention of esophageal variceal bleeding. But early bleeding after EVL occur from time to time, the prevention of early bleeding is directly related to the effect of EVL. There is no unified opinion about drug prophylaxis, especially octreotide in the prevention of early bleeding after EVL. The purpose of this study is to analyze the onset characteristics and precaution of the early bleeding after EVL, and to investigate whether octreotide prophylaxis can effectively decrease the early bleeding rate, the amount of bleeding and the mortality after hemorrhage.Methods: Retrospective studies were performed on the patients who accepted EVL from January 2002 to December 2008, 220 cases were treated in No 1 Hospital of Jilin University, 324 cases were treated in Jilin chemical Hospital. All patients diagnosed as liver cirrhosis were confirmed by laboratory examination, color Doppler ultrasound or CT. Endoscopic examination merely revealed moderate or severe esophageal varices which were only treated with endoscopic variceal ligation; excluding esophageal varices complicated peptic ulcer or portal hypertensive gastropathy and so on; excluding endoscopic injection sclerotherapy, histoacryl therapy or the former united with EVL, and esophageal varices or phlebangioma caused by primary hepatic carcinoma, Budd-Chiari syndrome, portal vein embolization, portal vein malformation or fibrosis. The records such as age, gender, degree of varices, whether applied octreotide for the prevention of early bleeding, whether bled early after EVL, inducement of bleeding, extent, way of bleeding, therapy and therapeutic results were summarized. According to whether bled after EVL and whether applied octreotide to prevent bleeding, patients were divided into bleeding groups, non-bleeding group and medication group, non- medication group. According to early postoperative bleeding number and the total number of EVL, the incidence of early bleeding after EVL was calculated. Then the peak time of onset, inducement, the amount of bleeding, the common way of bleeding and prognosis of early bleeding after EVL was analyzed. Medication group compared the influence with non-medication group on the early bleeding rate, the amount of bleeding and mortality after hemorrhage, whether octreotide can effectively prevent early postoperative bleeding was researched.Results:544 patients accepted EVL, there were 28 cases in bleeding group and 516 in non-bleeding group; 228 in medication group and 316 in non-medication group. 12 cases happened to bleed early after EVL in medication group, 4 cases died; in non-medication group were 16 cases, 6 died. The early bleeding rate was 5.15% (28/544), the mortality was 35.7% (10/28). Most early bleeding always occurred in the first 7-14 days after EVL, the constituent ratio was 64.28%. The first 7-14 days were the days that the scar tissue of ligation fell off, leaving superficial ulcers. It meant the hemorrhage happened in that time was caused by the ulcer located on varices. Improper diet was the main inducement of early bleeding after EVL, the constituent ratio was 32.14%. 25% patients had not found clear inducement of early bleeding after EVL, the bleeding may be related to the disease itself or the relevant factors which had not been found. The common way of bleeding is haematemesis, the constituent ratio was 85.71% (24/28). Chi-square test was used to compare the difference of early bleeding rate between two groups, P>0.05, the bleeding rate of two groups were no significant difference . The difference of mortality between two groups was examined by definite probability method, P>0.05, mortality in the two groups was no significant difference. The average amount of bleeding in 28 patients after EVL was 579.6±375.3ml. In medication group the average amount of bleeding was 520.8±436.7ml, and it was 626.7±326.2ml in the non-medication group. Nonparametric test was used to compare the difference between the amount of bleeding, there was no statistically significant difference (P>0.05), Medication group was not better than non-medication group in preventing early bleeding after EVL, reducing the amount of bleeding and mortality after hemorrhage.Conclusions: Endoscopic variceal ligation is a safe and effective method to cure esophageal varices. The onset characteristics of early bleeding after EVL is low incidence, but the volume of bleeding is large, hematemesis is the main performance, the mortality is quite high even through active rescue. Most early bleeding always happen at the first 7-14 days after EVL, it is critical time for preventing early bleeding after EVL. Improper diet is the main inducement of early bleeding after EVL. Nausea, physical activity, forced defecation is also an important incentive for the early bleeding after EVL. Octreotide prophylaxis can not reduce the early bleeding rate, the amount of bleeding and mortality after hemorrhage.