A Meta-analysis Of Risk Factors For Early Rebleeding After Endoscopic Variceal Ligation(EVL)

Objective:Esophageal variceal bleeding(EVB)is characterized by an acute onset and a large amount of bleeding,which may cause hemorrhagic shock and seriously compromise the life safety of patients,affecting the prognosis and long-term survival of patients if left untreated.Endoscopic variceal ligation(EVL)is often performed as the first choice treatment to prevent and treat EVB,improve patient outcomes and productivity,but the early postoperative rebleeding rate is still high.Therefore,proper recognition of risk factors for early rebleeding after EVL is essential to reduce this occurrence,as well as to improve patient outcomes and improve survival.This study provides a basis for clinical development of relevant preventive and therapeutic initiatives by analyzing the extant domestic and foreign literature on early rebleeding after EVL for esophageal varices to derive its independent risk factors.Methods:Relevant literature regarding the risk factors for early rebleeding after EVL was collected by searching various Chinese and English literature databases,including China National Knowledge Infrastructure,VIP,Wanfang,Pub Med,EMBASE,the Cochrane Library,and so on.An information search was conducted by combining subject headings with free word forms,and Chinese subject headings included""esophageal varices,""""endoscopic esophageal variceal cuffing,""""post-operative bleeding,""""risk factors,""and so on;Subject headings in English included""esophageal variants,""""endoscopic variant ligation,""""postoperative hemorrhage,""""risk factors,""and others;Chinese free words include""gastroesophageal varices"",""endoscopic cuff"",""postoperative bleeding"",""influencing factors"",and so on;Free words in English include""esophageal varix"",""endoscopic ligatures"",""loss,postoperative blood"",""social risk factors"",etc;The literature search time limit was set from the date of library construction until October 2022.After developing inclusion versus exclusion criteria,two investigators each completed the literature screening and material extraction to ensure data accuracy.Literature evaluation the NOS scale was used to perform a quality analysis of the included literatures.The revman5.3 software system was used to carry out the statistical analysis,first the heterogeneity test was performed,and if the conclusion of heterogeneity test indicated that there was an unequivocal heterogeneity characteristic(I~2≥85%)and the reason could not be determined,the meta-analysis was discarded.For the remaining suspected risk factors,the corresponding effect model was selected to parse and parallel sensitivity detection,and finally,the weighted mean difference(WMD)and 95%confidence interval(CI)were used to elaborate the continuous type variables,and the odds ratio(or)and 95%confidence interval(CI)were used to elaborate the dichotomous variables.Results:After strict screening and exclusion,12 related articles were finally identified,with a total of 3979 subjects.Meta analysis showed that the risk factors were no-small amount of ascites(OR=11.88,95%CI=2.00～70.62),moderate to large ascites(OR=0.03,95%CI=0.02～0.06),portal vein thrombosis(OR=0.12,95%CI=0.08～0.19),grade moderate of esophageal varices(OR=117.65,95%CI=36.78～376.34),grade severe of esophageal varices(OR=0.02,95%CI=0.00～0.10),Child-Pugh A(OR=7.84,95%CI=3.77～16.30),Child-Pugh B(OR=4.01,95%CI=2.62～6.13),Child Pugh C(OR=0.04,95%CI=0.02～0.08),and previous history of diabetes(OR=0.50,95%CI=0.33～0.76);the protective factors of early rebleeding after EVL operation mainly include lower child score(WMD=-2.14,95%CI=-2.57～1.70),lower fasting blood glucose(WMD=-1.23,95%CI:-1.74～0.72),the less the number of ligated veins(WMD=-1.61,95%CI=-1.72～-1.50),the higher the hemoglobin content(WMD=24.18,95%CI=21.78～26.57),the shorter the prothrombin time(WMD=-3.88,95%CI=-4.58～-3.18),the higher the prothrombin activity(WMD=11.03,95%CI=6.09～15.96),the less the number of skin rings used for ligation(WMD=-1.38,95%CI=-1.59～-1.17),the lower the alkaline phosphatase content(WMD=-51.38,95%CI=-74.27～-28.48),the less preoperative bleeding(WMD=-1018.14,95%CI=-1153.25,～883.03),and the less preoperative blood transfusion(WMD=-2216.83,95%CI=-2424.51～-2009.16);however,there was no statistical difference in esophageal varices grade mild between them.Conclusion:The risk of early rebleeding after EVL may be effectively reduced by a combination of improved liver function,decreased ascites volume,improved coagulation,aggressive glucose control,and aggressive intervention in patients with concomitant portal vein thrombosis.