Prediction of early rebleeding and mortality after sclerotherapy in patients with bleeding esophageal varices

ABSTRACT

Sclerotherapy is considered the most effective way to stop bleeding from esophageal varices, but acute variceal bleeding is still associated with high risk of rebleeding and mortality. Early prognostic assessment may he important in identifying those patients who will be at more risk. This work was conducted to study the predictors of early rebleeding and mortality after emergency sclerotherapy. The study included 102 patients with acute variceal bleeding who underwent emergency sclerotherapy. They were 82 men and 20 women with their ages ranged from 30-80 years [mean = 51.5]. The patients were followed for one week after sclerotherapy and the rates of rebleeding and mortality were recorded, Several clinical, biochemical, endoscopic, hematological, and therapeutic parameters were evaluated to assess their predictability for early rebleeding and mortality. The results showed that rebleeding occurred in 33 [31.4%] patients and death in 12 [11.8%] patients during the 7 days after the index bleed. Univariate analysis showed that the followings were significant in patients with rebleeding presence of ascites [P =0.001], use of balloon tamponade [P =0.00007], elevated levels of ALT [P =0.001], AST [P =0.0002], bilirubin [P =0.006], prothrombin time [PT] [P =0.006], serum creatinine [P =0.003], low serum albumin [P =0.046], large varices [P =0.007], presence of fundal varices [P =0.01], and the use of ethanolamine oleate in amount less than 10 mL or more than 20 mL [P =0.03]. In contrast, the presence of red signs showed no significant relation to rebleeding. Patients in Child A were at a significant less risk of rebleeding than patients in Child B or C.A logistic regression analysis of the significant variables showed that elevated ALT, AST, prolonged PT, presence of fundal varices, large varices, and the use of balloon tamponade to be the variables independently associated with rebleeding. Regarding early mortality, the results showed the presence of encephalopathy, rebleeding, and shrunken liver were the independent significant risk factors that predicted early mortality. In conclusion, patients who are at risk for early rebleeding and mortality can be identified and should be looked for early. It seems reasonable to start therapy with vasoactive agents in those patients and to continue therapy for several days after sclerotherapy