Risk Factors Of Early Rebleeding After Esophageal Variceal Ligation

BackgroundEsophageal variceal bleeding(EVB) is still unpredictable associated with a mortality of 20%to 40%,accounts for one-third of deaths among patients with cirrhosis,and continues despite initial adequate treatment.Rebleeding is common following variceal hemorrhage.Hypercoagulable events occur in cirrhosis patients with gastrointestinal bleeding(GIB) despite the well-known bleeding diathesis of liver disease.AimsTo determine risk factors for early rebleeding within 14 days in patients with cirrhosis after endoscopic variceal ligation(EVL).MethodsA total of 131 cirrhotic patients with esophageal varices who received elective or emergent EVL procedure were analyzed.The variables for risk factors analysis included the sex,age,hepatic coma,red color sign,complication,portal vein width,gastric varices,blood loss,transfusion volume,with or without portal vein thrombosis,exercise load,hard diet,etiology of cirrhosis,location and number of varices,history of devascularization or splenectomy,the Crade classification,Child-Pugh status,,ascites,basic laboratory data,with or without administration of proton pump inhibitor(PPI),somatostatin,hypophysin,thrombin,mucosal protective agents,β-blockers.ResultsThe sex,age,hepatic coma,portal vein width,gastric varices,blood loss,transfusion volume, portal vein thrombosis,exercise load,hard diet,location and number of varices,history of devascularization or splenectomy,the Crade classification,Child-Pugh status,,ascites, red color sign,esophagitis,AFP,albumin,hemoglobin,proton pump inhibitor(PPI), hypophysin,thrombin are significantly different between the two groups.Patients with portal vein thrombosis,prolonged prothrombin time,exercise load,hard diet,Child-Pugh status and hemoglobin were independently associated with the early rebleeding after EVL. Rebleeding within 14 days occurred in 13 patients(9.93%) with 5 deaths(38.5%).ConclusionsPortal vein thrombosis,prolonged prothrombin time,exercise load,hard diet,Child-Pugh status and hemoglobin are the independent risk factors for early rebleeding after EVL.Hard diet and heavy exercise load should be forbidden after EVL.We should also closely monitor the symptoms/signs of coagulation abnormalities in cirrhotic patients, especially in cirrhotic patients with poor liver reserve.