Risk factors for early rebleeding after initial sclerotherapy for esophageal varices / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the effect of initial esophageal variceal sclerotherapy (EVS) on liver function and blood biochemistry in patients with liver cirrhosis and the risk factors for early rebleeding after initial EVS. MethodsA retrospective analysis was performed for the clinical data of 120 cirrhotic patients with esophageal variceal bleeding who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from January 2016 to December 2017 and received initial EVS. The patients were divided into groups according to the Child-Pugh class, and liver function and blood biochemistry were compared between groups before and after treatment to evaluate the effect of EVS on the above indices. Early rebleeding after surgery was defined as bleeding within 14 days after surgery. The patients were divided into bleeding group and non-bleeding group according to the presence or absence of early rebleeding, and a logistic regression analysis was performed to investigate the main risk factors for early rebleeding. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test or the Fisher′s exact test was used for comparison of categorical data between groups. ResultsAfter treatment, Child-Pugh class A/B patients had significant changes in total bilirubin (Z=-3.975 and -3.670, both P＜0.001), direct bilirubin (Z=-3.455 and -3.086, P=0.001 and 0.002), and white blood cell count (Z=-2.811 and -3.683, P=0.005 and P＜0001). Early rebleeding rate after EVS was 10% (12/120). The logistic regression analysis showed that the amount of ascites (odds ratio ［OR］=2.92, P=0.047) and presence of portal vein thrombosis (OR=4.94, P=0.018) were independent risk factors for early rebleeding after EVS. ConclusionEVS does not have a significant impact on liver function, and bacterial infection should be taken seriously during treatment. The amount of ascites should be reduced before surgery, in order to reduce the incidence rate of early rebleeding after EVS. For patients with portal vein thrombosis, the risk of treatment should be evaluated and an appropriate treatment regimen should be selected based on patient′s conditions.