3548 The comparability of early rebleeding in patients with esophageal variceal bleeding treated with endoscopic injection sclerotherapy or endoscopic variceal ligation and maintained on propranolol.

Abstract

Background and Objectives: Endoscopic sclerotherapy (ES) and endoscopic variceal ligation (EVL) are accepted treatment for bleeding esophageal varices. We aim to determine which group of patients with esophageal variceal bleeding at index endoscopy treated with either injection sclerotherapy or variceal ligation and maintained on propranolol, had early rebleeding. In addition, we want to determine the variable that would best predict early rebleeding between the two groups. Methods: Fifty-four (54) documented cirrhotics with esophageal variceal bleeding at index endoscopy were included in the study. ES was performed with paravariceal/intravariceal injection of 1% polidocanol every 7 days, while Saeed 6-shooter multiband ligator (Wilson Cook, Winston-Salem, NC) was used every 10 days to the EVL group. Both procedures were repeated until there was complete obliteration of varices. All patients were then administered propranolol until there was 25% reduction in resting heart rate. Recurrence of bleeding was defined as any episode/s of melena or hematemesis occurring after complete variceal obliteration. Results: Forty-two out of 54 patients (78%) had episodes of rebleeding. Of these, 20 patients belonged to the ES group and 22 patients in the EVL group. There were no differences between the two groups in terms of age, sex, etiology of cirrhosis, variceal grade at index endoscopy and rebleeding and Child- Pugh class. (p>0.05). Mean follow-up period for the ES and EVL groups were 111.3+71 days and 197.9+124 days, respectively. Mean propranolol dose taken was 27.5±19.74 milligrams per day in the ES group and 27.7±18.39 for EVL patients (p>0.05). Mean treatment sessions for the ES and EVL group was 3.05±.37 and 2.82±.35, respectively (p>0.05). Time interval of bleeding recurrence in the ES group was 100.3±67 days while in the EVL group it was 195.4±135 days (p=0.007). Using multivariate analysis, Child-Pugh class and the type of endoscopic procedure were independent variables that could predict early rebleeding (p Conclusion: After complete variceal obliteration and propranolol maintenance, patients treated with endoscopic sclerotherapy had significantly earlier rebleeding interval compared to endoscopic variceal ligation. Furthermore, poorer Child-Pugh class and variceal obliteration by injection sclerotherapy may predict early rebleeding.