Risk factors for early rebleeding after elective endoscopic variceal ligation(EVL) and long-term outcome: a retrospective analysis / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the risk factors for early rebleeding (ERB) after elective endoscopic variceal ligation (EVL) in cirrhotic patients and the influence of ERB on the long-term survival.Methods A total of 198 cirrhotic patients who received elective EVL were retrospectively evaluated.Twenty-six patients rebleeded within 6 weeks after initial EVL and were assigned to the ERB group.One hundred and seventy-two other cirrhotic patients were assigned to the control group.Multivariate analysis was used to define the high risk factors of ERB.A Kaplan-Meier analysis was performed to evaluate the cumulative survival rates between two groups.Results The Child-Pugh classification (P =0.016),Child-Pugh scores (P=0.012),and the total bilirubin (P =0.001) were significantly different between ERB and control group.Multivariate analysis showed total bilirubin was the only independent risk factor of ERB (OR =2.02,95％CI1.04-4.04,P =0.008).The proportional mortality indicator of bleeding-related deaths was 66.7％ (10/15) in ERB group and 13.6％ (6/44) in control group (P ＜0.01).The five-year curmulative survival rate of the control-group was significantly higher than that of the rebleeding group (67.8％ vs.25.3％,P ＜ 0.01).Conclusion Cirrhotic patients with ERB after elective EVL have a poor prognosis.High level of total bilirubin may predict ERB.