Risk Factors for Bleeding Complications after Endoscopic Variceal Ligation Therapy

Zusammenfassung

Hintergrund: Ösophagusvarizenblutungen sind eine gefürchtete Komplikation der portalen Hypertension. Die endoskopische Gummibandligatur (ÖVL) stellt die Therapie der Wahl zur Behandlung der akuten Varizenblutung dar und wird auch zur Primär- und Sekundärprophylaxe von Varizenblutungen angewandt. Postinterventionell besteht das Risiko einer Re-Blutung. Risikofaktoren für Blutungskomplikationen nach ÖVL sind bisher wenig und nur an kleinen Patientenkollektiven untersucht. Methodik: Wir analysierten retrospektiv die Daten von Patienten, bei denen Ligaturbehandlungen durchgeführt wurden. Es wurde eine Vielzahl klinischer, laborchemischer und endoskopischer Daten analysiert. Ergebnisse: 255 Patienten und 387 Ligatursitzungen wurden in die Analyse eingeschlossen. Patienten mit Blutungskomplikation hatten im Vergleich eine eingeschränkte Leberfunktion gemessen an höherem Child-Pugh-Score (10,5 vs. 8, p = 0,002), niedrigerem Serum-Albumingehalt (26,5 vs. 31,9 [g/L], p = 0,0001) und niedrigerem Quick (46,5 vs. 70 [%], p = 0,0001). Bakterielle Infektionen traten signifikant häufiger bei Patienten mit postinterventioneller Blutung auf, Leukozyten als Entzündungsparameter waren ebenfalls signifikant erhöht (9,5 vs. 6,5 [× 10⁹ /L], p = 0,030). Die Herzfrequenz war bei Patienten mit Blutungsereignis im Vergleich höher (80 vs. 72 [Schläge/min], p = 0,017), außerdem zeigten sich Hämoglobin- (5,9 vs. 6,4 [mmol/L], p = 0,028) und Hämatokrit-Werte (0,280 vs. 0,314; p = 0,031) erniedrigt. Des Weiteren erlitten jüngere Patienten häufiger Nachblutungen (52,5 vs. 58 [Jahre], p = 0,012). Schlussfolgerung: Zur Kalkulation des Nachblutungsrisikos stehen einfach zu erhebende klinische Parameter zur Verfügung, die rasch eine Aussage über das Blutungsrisiko geben können.

Abstract

Background: Bleeding from esophageal varices is a severe complication of portal hypertension. Endoscopic band ligation (EBL) is the treatment of choice for acute variceal bleeding. It is also performed for primary and secondary prophylaxis of bleeding from esophageal varices. After EBL, patients are at risk of postinterventional bleeding; the risk factors for this complication are poorly evaluated. Methods: We retrospectively analyzed data from patients who underwent EBL. We evaluated clinical data, laboratory and endoscopic findings. Results: 255 patients with 387 ligation sessions were included in the analysis. Patients with bleeding complications had a significantly higher severity of liver disease as measured by a higher Child-Pugh score (10.5 vs. 8, p = 0.002), lower albumin (26.5 vs. 31.9 [g/L], p = 0.0001) and lower prothrombin activity (46.5 vs. 70 [%], p = 0.0001). The incidence of bacterial infection was significantly higher in patients with postinterventional bleeding. As well, the white blood cell count was significantly higher in the bleeding group (9.5 vs. 6.5 [× 10⁹ /L], p = 0.030). In patients with bleeding events we observed an elevated heart rate compared to those without this complication (80 vs. 72 [bpm], p = 0.017). Furthermore, we found a lower hemoglobin level (5.9 vs. 6.4 [mmol/L], p = 0.028) and a lower hematocrit (0.280 vs. 0.314, p = 0.031) in the bleeding group. Younger patients suffered more often from postinterventional bleeding (52.5 vs. 58 [years], p = 0.012). Conclusion: There are clinical data which can be ascertained easily in order to reflect the risk of bleeding complications after EBL.

Schlüsselwörter

Ösophagusvarizen - endoskopische Gummibandligatur (ÖVL) - Varizenblutungen - Leberzirrhose - portale Hypertension - Komplikationen - Risikofaktoren - Nachblutungen

Key words

esophageal varices - endoscopic band ligation (EBL) - variceal bleeding - liver cirrhosis - portal hypertension - complications - risk factors - rebleeding

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