SELF-EXTENDABLE METAL STENT AS SALVAGE TREATMENT MODALITY IN ACUTE SEVERE VARICEAL BLEEDING

Aims The use of the self-extendable metal stent (SEMS) in severe esophageal variceal bleeding (EVB) is gaining recognition. The aim of the study was to assess factors associated with early rebleeding.

Methods Fifty-nine patients with EVB treated with placement of SEMS from January 2011 to November 2019 in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw) were retrospectively analyzed. The primary outcome measure was 5- day control bleeding. The secondary outcome measure was early rebleeding within 6 weeks. The Chi-square distribution, logistic regression and ROC curve were used for analysis.

Results The main aetiology of liver cirrhosis was alcoholic liver disease (26 patients; 44.8%). Median Model for End-stage Liver Disease (MELD) score was 24, median of blood units transfused was 9. Five-day failure to control bleeding was observed in 17 patients (29.3%). Rebleeding within 6 weeks was observed in 10 patients (17.2%). The successful 5-day bleeding control was higher when fibrinogen concentration was above 126 mg/dL (52.3% vs 18.2%; p = 0.029; AUC = 0.68; 95% CI: 0.503–0.846). No other liver dysfunction variables, such as platelet count (p > 0.05) or MELD (p > 0.05), were found affecting five days bleeding risk.

Conclusions Fibrinogen concentration affect early rebleeding from severe esophageal variceal in patients with salvage treatment with SEMS placement.