Universität zu Köln

Drolz, Andreas, Schramm, Christoph, Seiz, Oliver, Groth, Stefan, Vettorazzi, Eik, Horvatits, Thomas, Wehmeyer, Malte H., Schramm, Christoph, Goeser, Tobias, Roesch, Thomas, Lohse, Ansgar W. and Kluwe, Johannes . Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis. Endoscopy. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1438-8812

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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 x 10(9)/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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Drolz, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Schramm, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Seiz, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Groth, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Vettorazzi, Eik UNSPECIFIED UNSPECIFIED UNSPECIFIED Horvatits, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Wehmeyer, Malte H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schramm, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Goeser, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Roesch, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Lohse, Ansgar W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kluwe, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-319646
DOI:	10.1055/a-1214-5355
Journal or Publication Title:	Endoscopy
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1438-8812
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROSPECTIVE RANDOMIZED-TRIAL; FRESH-FROZEN PLASMA; PORTAL-HYPERTENSION; LIVER-DISEASE; INVASIVE PROCEDURES; BAND LIGATION; COAGULATION; SCLEROTHERAPY; HEMOSTASIS; MANAGEMENT Multiple languages Gastroenterology & Hepatology; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31964