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Endoscopy 2021; 53(03): 226-234
DOI: 10.1055/a-1214-5355
Original article

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

Andreas Drolz‡   *
1   Department of Internal Medicine I, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Christoph Schramm‡   *
2   Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
,
Oliver Seiz
1   Department of Internal Medicine I, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Stefan Groth
3   Department of Interdisciplinary Endoscopy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Eik Vettorazzi
4   Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg, Germany
,
Thomas Horvatits
1   Department of Internal Medicine I, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Malte H. Wehmeyer
1   Department of Internal Medicine I, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Christoph Schramm
1   Department of Internal Medicine I, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Tobias Goeser
2   Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
,
Thomas Roesch
3   Department of Interdisciplinary Endoscopy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Ansgar W. Lohse
1   Department of Internal Medicine I, University Medical Center Hamburg Eppendorf, Hamburg, Germany
,
Johannes Kluwe
1   Department of Internal Medicine I, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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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.

* These authors contributed equally to this work.


Supplementary material



Publication History

Received: 04 September 2019

Accepted: 02 June 2020

Article published online:
07 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Refers to:

Author commentary on Andreas Drolz et al.Endoscopy 2021; 53(03): v11-v11
DOI: 10.1055/a-1214-8882

 

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