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Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis

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Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis. / Drolz, Andreas; Schramm, Christoph; Seiz, Oliver; Groth, Stefan; Vettorazzi, Eik; Horvatits, Thomas; Wehmeyer, Malte H; Schramm, Christoph; Goeser, Tobias; Roesch, Thomas; Lohse, Ansgar W; Kluwe, Johannes.

in: ENDOSCOPY, Jahrgang 53, Nr. 3, 03.2021, S. 226-234.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Drolz, A, Schramm, C, Seiz, O, Groth, S, Vettorazzi, E, Horvatits, T, Wehmeyer, MH, Schramm, C, Goeser, T, Roesch, T, Lohse, AW & Kluwe, J 2021, 'Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis', ENDOSCOPY, Jg. 53, Nr. 3, S. 226-234. https://doi.org/10.1055/a-1214-5355

APA

Drolz, A., Schramm, C., Seiz, O., Groth, S., Vettorazzi, E., Horvatits, T., Wehmeyer, M. H., Schramm, C., Goeser, T., Roesch, T., Lohse, A. W., & Kluwe, J. (2021). Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis. ENDOSCOPY, 53(3), 226-234. https://doi.org/10.1055/a-1214-5355

Vancouver

Drolz A, Schramm C, Seiz O, Groth S, Vettorazzi E, Horvatits T et al. Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis. ENDOSCOPY. 2021 Mär;53(3):226-234. https://doi.org/10.1055/a-1214-5355

Bibtex

@article{0dce868454584e3280ab854b4a5717cc,
title = "Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis",
abstract = "BACKGROUND: Prophylactic endoscopic variceal band ligation (EVL) is frequently performed in patients with liver cirrhosis. The aim of our study was to identify factors associated with early upper gastrointestinal bleeding (UGIB) in cirrhosis patients after prophylactic EVL.METHODS: 787 nonemergency EVLs performed in 444 patients in two German University medical centers were analyzed retrospectively.RESULTS: Within 30 days after EVL, 38 UGIBs were observed (4.8 % of all procedures). Bilirubin levels (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2-2.0 for a 2-fold increase) and presence of varices grade III/IV according to Paquet (HR 2.6, 95 %CI 1.3-5.0 compared with absence or smaller sized varices) were independently associated with UGIB following EVL. International normalized ratio (INR) was associated with bleeding events in the univariate analysis but did not reach statistical significance after adjustment for bilirubin and presence of varices grade III/IV (HR 1.2, 95 %CI 0.9-1.6 for an increase by 0.25). There was no statistically significant association between platelet count or fibrinogen levels and UGIB. Substitution of coagulation products did not affect incidence of bleeding after EVL, which also applied to patients with {"}coagulopathy{"} (INR > 1.5 and/or platelet count < 50 × 109/L). No association between proton pump inhibitor therapy and post-EVL UGIB was observed.CONCLUSIONS: EVL is a safe procedure and immediate bleeding complications are rare. Serum bilirubin levels and size of varices, rather than coagulation indices, are associated with UGIB after EVL. Our data do not support the preventive substitution of blood or coagulation products.",
author = "Andreas Drolz and Christoph Schramm and Oliver Seiz and Stefan Groth and Eik Vettorazzi and Thomas Horvatits and Wehmeyer, {Malte H} and Christoph Schramm and Tobias Goeser and Thomas Roesch and Lohse, {Ansgar W} and Johannes Kluwe",
note = "Thieme. All rights reserved.",
year = "2021",
month = mar,
doi = "10.1055/a-1214-5355",
language = "English",
volume = "53",
pages = "226--234",
journal = "ENDOSCOPY",
issn = "0013-726X",
publisher = "Georg Thieme Verlag KG",
number = "3",

}

RIS

TY - JOUR

T1 - Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis

AU - Drolz, Andreas

AU - Schramm, Christoph

AU - Seiz, Oliver

AU - Groth, Stefan

AU - Vettorazzi, Eik

AU - Horvatits, Thomas

AU - Wehmeyer, Malte H

AU - Schramm, Christoph

AU - Goeser, Tobias

AU - Roesch, Thomas

AU - Lohse, Ansgar W

AU - Kluwe, Johannes

N1 - Thieme. All rights reserved.

PY - 2021/3

Y1 - 2021/3

N2 - BACKGROUND: Prophylactic endoscopic variceal band ligation (EVL) is frequently performed in patients with liver cirrhosis. The aim of our study was to identify factors associated with early upper gastrointestinal bleeding (UGIB) in cirrhosis patients after prophylactic EVL.METHODS: 787 nonemergency EVLs performed in 444 patients in two German University medical centers were analyzed retrospectively.RESULTS: Within 30 days after EVL, 38 UGIBs were observed (4.8 % of all procedures). Bilirubin levels (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2-2.0 for a 2-fold increase) and presence of varices grade III/IV according to Paquet (HR 2.6, 95 %CI 1.3-5.0 compared with absence or smaller sized varices) were independently associated with UGIB following EVL. International normalized ratio (INR) was associated with bleeding events in the univariate analysis but did not reach statistical significance after adjustment for bilirubin and presence of varices grade III/IV (HR 1.2, 95 %CI 0.9-1.6 for an increase by 0.25). There was no statistically significant association between platelet count or fibrinogen levels and UGIB. Substitution of coagulation products did not affect incidence of bleeding after EVL, which also applied to patients with "coagulopathy" (INR > 1.5 and/or platelet count < 50 × 109/L). No association between proton pump inhibitor therapy and post-EVL UGIB was observed.CONCLUSIONS: EVL is a safe procedure and immediate bleeding complications are rare. Serum bilirubin levels and size of varices, rather than coagulation indices, are associated with UGIB after EVL. Our data do not support the preventive substitution of blood or coagulation products.

AB - BACKGROUND: Prophylactic endoscopic variceal band ligation (EVL) is frequently performed in patients with liver cirrhosis. The aim of our study was to identify factors associated with early upper gastrointestinal bleeding (UGIB) in cirrhosis patients after prophylactic EVL.METHODS: 787 nonemergency EVLs performed in 444 patients in two German University medical centers were analyzed retrospectively.RESULTS: Within 30 days after EVL, 38 UGIBs were observed (4.8 % of all procedures). Bilirubin levels (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2-2.0 for a 2-fold increase) and presence of varices grade III/IV according to Paquet (HR 2.6, 95 %CI 1.3-5.0 compared with absence or smaller sized varices) were independently associated with UGIB following EVL. International normalized ratio (INR) was associated with bleeding events in the univariate analysis but did not reach statistical significance after adjustment for bilirubin and presence of varices grade III/IV (HR 1.2, 95 %CI 0.9-1.6 for an increase by 0.25). There was no statistically significant association between platelet count or fibrinogen levels and UGIB. Substitution of coagulation products did not affect incidence of bleeding after EVL, which also applied to patients with "coagulopathy" (INR > 1.5 and/or platelet count < 50 × 109/L). No association between proton pump inhibitor therapy and post-EVL UGIB was observed.CONCLUSIONS: EVL is a safe procedure and immediate bleeding complications are rare. Serum bilirubin levels and size of varices, rather than coagulation indices, are associated with UGIB after EVL. Our data do not support the preventive substitution of blood or coagulation products.

U2 - 10.1055/a-1214-5355

DO - 10.1055/a-1214-5355

M3 - SCORING: Journal article

C2 - 32894867

VL - 53

SP - 226

EP - 234

JO - ENDOSCOPY

JF - ENDOSCOPY

SN - 0013-726X

IS - 3

ER -