Endoscopic variceal ligation for primary prophylaxis of esophageal variceal hemorrhage in pre-liver transplant patients

Abstract

Endoscopic variceal ligation (EVL) is widely used to prevent esophageal variceal bleeding in patients with advanced cirrhosis. However, the safety and efficacy of EVL in this setting have not been clearly established. This study included 300 adult patients with cirrhosis on our liver transplant waitlist who underwent upper gastrointestinal endoscopy. Esophageal varices deemed to be at high risk of bleeding were banded until eradication or transplantation. A retrospective review of patient notes and endoscopy databases was undertaken, and the number of banding episodes, complications, and patient outcomes were recorded. Forty-two of 300 patients presented with or had previous variceal bleeding prior to referral and were excluded from the analysis. Of the remaining 258 patients, 101 underwent a total of 259 banding episodes (2.6 per patient) with a median follow-up post-banding of 18.4 months per patient (a total of 150 patient years). Failed prophylaxis occurred in 2 patients (2%), and there were 3 episodes (1.2%) of acute hematemesis from band-induced ulceration. One patient (1%) had mild esophageal stricturing post-banding without dysphagia. Four of 36 patients (11%) previously found to have moderately sized or larger varices that were not banded presented with hematemesis due to variceal bleeding and were subsequently banded. None of the patients that received banding died because of bleeding or failed to receive a transplant as a result of banding complications. This study shows that in liver transplant candidates, EVL is highly effective in preventing first variceal bleed. Although banding carries a small risk of band-induced bleeding, this rate is low in comparison with the predicted rate of variceal bleeding in this population. Liver Transpl 15:1508Transpl 15: -1513Transpl 15: , 2009

The Effect of Rabeprazole on Injection Sclerotherapy Complications after First Attack Bleeding Esophageal Varices

“…There were no statistically significant differences between group I and group II regarding all sonographic data e.g. liver size, portal vein diameter, presence and amount of ascites and spleen size as shown in table (3). Table ( 4) shows that, there are no statistically significant baseline differences between cases and controls regarding laboratory parameters including (hemoglobin concentration, total leukocytic count, platelet count, albumin level, total and direct bilirubin levels), ALT, AST, PT, INR, and serum creatinine level.…”

“…Although 50% of all esophageal variceal bleeding episodes stop spontaneously, the rebleeding rate is high with about 50% of patients experiencing a second episode, usually within 2 weeks from the first episode. A second episode of bleeding puts the patient at a high mortality risk and is thus the reason for starting therapy as soon as possible [3]. Endoscopic sclerortherapy should be performed early after hospital admission, assuring that the patient is resuscitated and hemodynamically stable [4].…”

Incidence of Bleeding and Thrombosis in Patients with Liver Disease

“…29,30 Endoscopic variceal band ligation (EVL) is associated with band-induced ulceration bleeding in 1.2 to 7.3% of patients. 31,32 Lim et al reported the lowest rate of bleeding of 1.2% (3/258) from retrospective chart review of patients undergoing EVL for primary prophylaxis in patients awaiting liver transplantation (LT). 32 A prospective study of unselected patients (primary and secondary prophylaxis with varying disease severity) reported a higher incidence of bleeding of 7.3% (11/150) post EVL.…”

“…31,32 Lim et al reported the lowest rate of bleeding of 1.2% (3/258) from retrospective chart review of patients undergoing EVL for primary prophylaxis in patients awaiting liver transplantation (LT). 32 A prospective study of unselected patients (primary and secondary prophylaxis with varying disease severity) reported a higher incidence of bleeding of 7.3% (11/150) post EVL. 31 They noted a higher incidence with increased disease severity (17% in CPC C vs. 4…”

Serum cholinesterase as liver function test in cirrhotic patients at Soba Teaching hospital, Khartoum, Sudan

“…Small blood vessels exude from red spots that are pinhead-sized. Fluid buildup in the legs and feet (edema) and in the abdomen (ascites), itching, occasionally reddish and blotchy palms, a condition known as palmar erythema are some of the symptoms that start to develop as cirrhosis progresses to the decompensated stage., swelling of breasts or shrinkage of the testicles may occur in men, as well as easy bruising and excessive bleeding (Lim et al, 2009).…”