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, Vol. 53, No. 3, 03.2021, p. 226-234.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -