Impact of Endoscopic Band Ligation on Bleeding Incidence in Patients with Chronic Liver Disease and High-Risk Varices. (March 2023)

• Record Type: Journal Article
• Authors: Gulotta, M.; Giuffrè, M.; Loddo, M.; Visintin, A.; Abazia, C.; Faini, C.; Masutti, F.; Crocè, L.S.
• Is Part Of: Digestive and liver disease. Volume 55(2023)Supplement 1
• Page Start: S49
• Page End: S50
• Publication Date: 2023-03
• Subjects: Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2023.01.097
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract : Introduction: Baveno VII guidelines preferred the use of non-selective beta-blockers (NSBB) as primary prophylaxis (PP) of high-risk varices (HRV) in patients with chronic liver disease in accordance with data showing that the 2-year bleeding rates of 14% in patients undergoing NSBB treatment. Aim: evaluate the cumulative incidence of esophageal varices bleeding in patients with chronic liver diseases treated with endoscopic band ligation (EBL). Material and Methods: We enrolled 153 consecutive patients referred to the Liver Clinic from 01/01/2016 to 31/12/2019, with chronic liver disease undergoing variceal endoscopic screening and evidence of HRV, not in PP for any kind of intervention (i.e., EBL and NSBB) or with previous events of variceal bleeding. After the first EBL, each patient was followed-up every 21 days upon variceal eradication. After successful eradication, endoscopy was repeated after 1-3 months and then after 6-12 months. Data were analyzed according to competitive risk analyses (competitive event=death), and predictors of variceal bleeding were described with sub-hazard ratios (sHR). Results: Patients were predominantly males (62%), with a median age of 72 (61;80) years. The most prevalent etiology of chronic liver disease was alcohol (37.2%). 65.4% and 18.3% of patients were in Child-Pugh (CP) classes B and C, respectively. Forty-nine (32%) patients had at least one episode of variceal bleeding during the follow-up period. In particular, the cumulative incidence of bleeding ( Figure ) varies from 2% (10 months after EBL) to 26% (60 months after EBL). Total bilirubin (sHR 1.40 [95% C.I. 1.20-1.90], p=0.001), INR (sHR 2.7 [95% C.I. 1.4-5.6], p<0.001) and Platelet Count < 100.000 (sHR 3.2 [1.9-6.10], p=0.039) were the most significant predictors of variceal bleeding. Conclusion: patients with higher CP scores show high rates of variceal bleeding despite successful eradication and appropriate follow-up, showing that in view of long-term follow-up, other interventional strategies for PP should be preferred.