Rates of recurrent variceal bleeding are low with modern esophageal banding strategies: a retrospective cohort study.

Abstract:

BACKGROUND:Variceal bleeding has a high rate of mortality and recurrence. Endoscopic band ligation (EBL) is the established standard of care for secondary prevention of variceal bleeding. OBJECTIVE:To determine the long-term re-bleeding rate of an EBL protocol similar to current society guidelines. DESIGN:We conducted a retrospective cohort study at a tertiary care center of all patients with a history of a variceal bleed who underwent an aggressive band ligation protocol. INTERVENTIONS:At the time of sentinel bleed, all varices, regardless of size, were ligated. EBL was then repeated every 2 weeks until stabilization, and all visible varices were ligated. The interval between banding sessions then increased. MAIN OUTCOME MEASUREMENTS:The incidence of re-bleeding was calculated as the time between clinical stabilization after the sentinel event until data censoring, which occurred at time of re-bleed, death, transplant or loss-to-follow up. Gastric variceal bleeding was a secondary endpoint. RESULTS:N = 176 patients were treated with aggressive EBL, and followed for a median of 16 months (range, 3 months - 6.9 years). The 6 month incidence of re-bleeding was 2.3%, the 12 month incidence was 3.4%, and the 2 year incidence was 4.6%. Overall, aggressive EBL was well-tolerated. One patient died during follow-up secondary to a gastric variceal bleed. CONCLUSIONS:Aggressive EBL yields a low rate of re-bleeding when compared to standard practice. Secondary prophylaxis with aggressive EBL should be a consideration for patients following a sentinel bleeding event.

journal_name

Scand J Gastroenterol

authors

Branch-Elliman W,Perumalswami P,Factor SH,Sled SM,Flamm SL

doi

10.3109/00365521.2015.1027263

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

1059-67

issue

9

eissn

0036-5521

issn

1502-7708

journal_volume

50

pub_type

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