P-124 TITLE: CLINICAL CHARACTERISTICS OF CIRRHOTIC PATIENTS WITH VARICEAL BLEEDING IN A SINGLE CENTER EXPERIENCE. DESCRIPTIVE STUDY

Introduction and Objectives

The variceal bleeding mortality in cirrhotic patients continues to be 15%-20%. Standard therapy and risk stratification have decreased the failure in bleeding control, risk of rebleeding, and mortality. This study aimed to describe the clinical characteristics of cirrhotic patients with variceal bleeding between 2016 to 2019, the treatment performed, the failure to bleeding control, the risk of rebleeding, and mortality.

Materials and Methods

A cross-sectional study of cirrhotic patients older than 18 years with variceal hemorrhage. Demographic and clinical data were collected. We performed descriptive statistics with mean, absolute and relative frequencies.

Results

92 patients were included, mean age 58 years, 54% men, CHILD PUGH A 27%, B 41% and C 29%, MELD mean 14 points; etiology of cirrhosis was alcoholic 30%, autoimmune 29%, viral 12%. Previous bleeding 42%. In secondary prophylaxis 80%, 10% of patients achieved the beta-blockade hemodynamic goal. The use of vasoactive agents was in 86% of patients, terlipressin was used in 97%. Restrictive transfusion therapy in 36%. Use of prokinetic 13%. Antibiotic prophylaxis is 90%, with ampicillin sulbactam at 84%. Digestive endoscopy was performed on average 7 hours after admission. Bleeding from esophagogastric varices 92%, GOV-2 3%, and active bleeding 45%. Successful endoscopic band ligation in 87%, cyanoacrylate in 42% of gastric varices. 38% with an indication for preemptive-TIPS, it was not performed in 56% with the clinical indication. 13% required esophageal stent placement. Rescue TIPS in 3% of patients. The rebleeding rate at five days was 10%. Mortality of 9% at six weeks.

Conclusions

The treatment of the patients with variceal bleeding in our single-center experience was according to the standard therapy described. Preemptive-TIPS was only considered in 44% of patients. Refractory bleeding and bleeding control failure were correlated with other studies published. Mortality was only 9%. Secondary prophylaxis and preemptive-TIPS should be reinforced when the indication exists.