Risk Factors Of Early Rebleeding After Endoscopic Treatment For Esophageal Varice

Objective:By comparing the clinical characteristics of patients with esophageal varices and the occurrence of early rebleeding after endoscopic treatment, we will find and confirm the major risk factor for early rebleeding after endoscopic treatment. In addition, we will also explore the clinical significance of these risk factors in predicting the early rebleeding.Materials and method:In total,58patients with esophageal varices underwent endoscopic treatments in the department of Gastroenterology of Provincial Hospital Affiliated to Shandong University between August2011to October2013. All information associated of patients was collected, such as Child-pugh grade, endoscopic treatment method, endoscopic characteristics of esophageal varices and imaging results. All patients received follow-up examinations of the situation of early bleeding including the time of bleeding and the amount of bleeding, clinical features and early rebleeding was analyzed by Chi-square test were used to compare qualitative variable. Survival curves were generated using Kaplan-Meier curve, and Log-rank test was used to compare patients’early bleeding between subgroup. Multivariate analysis was performed by the Cox-regression model. Receiver operating characteristic (ROC) analysis was used to determine the predictive value of the risk factors..Result:1.In total,58patients entered into the group, male patients were42cases, female patients were16cases, The mean age was54.3±12.1years. Treated with EVL was 21patients (36%), Treated with EIS was30patients(52%), Combined treatment with EVL and EIS was7patients (12%). Period of postoperative follow-up, A total of10patients appeared early rebleeding, Treated with EVL group was6patients,Treated with EIS group was3patients, Combined treatment with EVL and EIS group was1patient,Death caused of bleeding was2patients.2. There were4factors had significantly correlated between two groups,Including the liver function Child-pugh grade(P=0.008),the formation of portal vein embolus (P=0.005),Preoperative degree of ascites(P=0.005) and Preoperative degree of varices,(P=0.043).But,Hemoglobin (HB),white blood cells (WBC),platelet (PLT),Aspartate aminotransferase(AST), alanine transaminase(ALT),albumin (ALB),total bilirubin (TBIL),prothrombin time (PT),fibrinogen (Fig), urea nitrogen (BUN) were not the risk factors for early rebleeding.(P>0.05)3. By researching the clinical characteristics of patients,we find preoperative degree of varices (P=0.034),preoperative degree of ascites (P=0.007), preoperative liver function Child-pugh grading (P<0.0001),serum urea nitrogen level (P=0.017), serum albumin level (P=0.026), preoperative of varices red sign (P=0.001) were significantly influence patients with Total no early rebleeding rate.Analyzed by Cox-regression models,We find the level of serum urea nitrogen ([HR]=1.346, P=0.015) and preoperative degree of ascites (HR=3.185, P=3.185)were the independent risk factors for early rebleeding after endoscopic treatment.4ROC analysis was used to determine the predictive value of the risk factors for early rebleeding. We find the level of blood urea nitrogen and the preoperative degree of ascites,Which the area under the curve under (AUC) were0.683(P=0.071) and0.801(P=0.003).And the diagnosis efficiency of ascites was superior than another clinical features.Conclusion:1. Preoperative degree of varices, preoperative degree of ascites, preoperative Child-pugh grade, serum urea nitrogen level, serum albumin level, and preoperative varices red sign is the risk factors influence varices early rebleeding after endoscopic treatment. The urea nitrogen levels and preoperative ascites are the independent risk factors.2. Preoperative ascites in patients can effectively determine the prognosis of varices early rebleeding after endoscopic treatment in patient.