Risk factors for early rebleeding after elective endoscopic variceal ligation（EVL） and long-term out- come： a retrospective analysis

Abstract

Objective To evaluate the risk factors for early rebleeding （ERB） after elective endo- scopic variceal ligation （EVL） in cirrhotic patients and the influence of ERB on the long-term survival. Methods A total of 198 cirrhotic patients who received elective EVL were retrospectively evaluated. Twen- ty-six patients rebleeded within 6 weeks after initial EVL and were assigned to the ERB group. One hundred and seventy-two other cirrhotic patients were assigned to the control group. Multivariate analysis was used to define the high risk factors of ERB. A Kaplan-Meier analysis was performed to evaluate the cumulative sur- vival rates between two groups. Results The Child-Pugh classification （ P = 0. 016 ）, Child-Pugh scores （P =0. 012）, and the total bilirubin （P = 0. 001 ） were significantly different between ERB and control group. Multivariate analysis showed total bilirubin was the only independent risk factor of ERB （ OR = 2.02, 95%CI： 1.04-4.04, P = 0.008）. The proportional mortality indicator of bleeding-related deaths was 66. 7% （10/15） in ERB group and 13.6% （6/44） in control group （P 〈0. 01 ）. The five-year cumulative survival rate of the control-group was significantly higher than that of the rebleeding group （ 67. 8% vs. 25.3%, P 〈 0. Ol ）. Conclusion Cirrhotic patients with ERB after elective EVL have a poor prognosis. High level of total bilirubin may predict ERB. Key words: Liver cirrhosis; Esophageal varices; Rebleeding; Endoscopic variceal ligation