Abstracts of the 2023 Annual Meeting of the ALEH
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Introduction and ObjectivesVariceal bleeding accounts for 10-30% of cases of upper gastrointestinal bleeding and is the most common complication of portal hypertension. The treatment of choice is endoscopic band ligation. Post-banding ulcer bleeding (PBUB), although infrequent, is a complication. Objectives: To determine the predictive factors of bleeding due to PBUB in cirrhotic patients.
Patients / Materials and MethodsThis is a case-control study involving cirrhotic patients with esophageal varices who developed PBUB (cases) and those who did not develop PBUB (controls).
Results and DiscussionFrom January 2012 to January 2024, 203 patients diagnosed with esophageal varices due to cirrhosis were included; 105 were men (51.7%) with a mean age of 57.8±10.9 years. The causes of cirrhosis were: 87 (42.9%) alcohol, 20 (9.9%) viral, 96 (47.3%) MASLD. According to the Child-Pugh classification: 53 (26.1%) were class A, 77 (37.9%) were class B, and 73 (36.0%) were class C. The indications for endoscopy were: 43 (21.2%) primary prophylaxis, 84 (41.4%) secondary prophylaxis, and 76 (37.4%) active bleeding. A total of 160 patients (78.8%) were taking non-selective beta-blockers (BBNS). We found 61 cases (30.0%) of PBUB.
In the univariate analysis, the following were associated with a higher risk of developing PBUB: post-ligation fibrosis [32/136 (23.5%) vs. 29/67 (43.3%); OR=1.8; 95% CI: 1.2-2.8; p=0.004], the presence of endoscopic signs of poor prognosis [13/122 (10.7%) vs. 48/81 (59.2%); OR=5.6; 95% CI: 3.2-9.6; p<0.0001], and the decompensated state of cirrhosis [Child A: 2/53 (3.8%) vs. Child B: 17/77 (22.1%) OR=7.2; 95% CI: 1.6-32.8 vs. Child C: 42/73 (57.5%) OR=34.5; 95% CI: 7.8-152.8; p<0.0001]. The multivariate analysis is shown in Table 1.
ConclusionsGreater cirrhosis decompensation is associated with a higher risk of PBUB; the presence of red signs of poor prognosis at the time of endoscopy also has an influence.
