Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long‐term cohort study

Cho, Hourin; Nagata, Naoyoshi; Shimbo, Takuro; Sakurai, Toshiyuki; Sekine, Katsunori; Okubo, Hidetaka; Imbe, Koh; Watanabe, Kazuhiro; Mikami, Shintaro; Yokoi, Chizu; Kobayakawa, Masao; Mizokami, Masashi; Yanase, Mikio; Akiyama, Junichi; Uemura, Naomi

doi:10.1111/hepr.12692

Cited by 22 publications

(22 citation statements)

References 20 publications

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“…In addition, hepatocellular carcinoma was also an independent risk factor for 6-week mortality of EVH post EVL according to multivariate hazard Cox analysis with parameters of scoring systems included. This finding was the same as previous studies, and portal thrombosis induced advanced portal hypertension was suggested as the reason[ 21 – 23 ]. So, the cut-off point for predicting 6-week mortality was different after subgroup analysis according to with or without a history of hepatocellular carcinoma.…”

Section: Discussionsupporting

confidence: 92%

Application of chronic liver failure-sequential organ failure assessment score for the predication of mortality after esophageal variceal hemorrhage post endoscopic ligation

Wong¹,

Chen²,

Chen³

et al. 2017

PLoS ONE

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BackgroundEsophageal variceal hemorrhage (EVH) is one of the high mortality complications in cirrhotic patients. Endoscopic variceal ligation (EVL) is currently the standard therapy for EVH. However, some patients have expired during hospitalization or survived shortly after management.AimTo evaluate hospital and 6-week mortality by receiver operating characteristic (ROC) curve of chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score compared to a model for end-stage liver disease (MELD) score and Child–Turcotte–Pugh (CTP) class.MethodsWe retrospectively collected 714 cirrhotic patients with EVH post EVL between July 2010 and June 2016 at Taitung MacKay Memorial Hospital, Taiwan. CLIF-SOFA score, MELD score, and CTP class were calculated for all patients admitted.ResultsAmong the 714 patients, the overall hospital and 6-week mortality rates were 6.9% (49/715) and 13.1% (94/715) respectively. For predicting hospital death, area under receiver operating characteristic curve (AUROC) values of CLIF-SOFA score, MELD score, and CTP class were 0.964, 0.876, and 0.846. For predicting 6-week death, AUROC values of CLIF-SOFA score, MELD score, and CTP class were 0.943, 0.817, and 0.834. CLIF-SOFA score had higher AUROC value with statistical significance under pairwise comparison than did MELD score and CTP class in prediction of not only hospital but also 6-week mortality. The history of hepatocellular carcinoma was the risk factor for 6-week mortality. For patients with hepatocellular carcinoma the cut-point of CLIF-SOFA score was 5.5 for 6-week mortality and 6.5 for hospital mortality on admission. For patients without hepatocellular carcinoma, the cut-point of CLIF-SOFA score was 6.5 for both 6-week and hospital mortality.ConclusionCLIF-SOFA score predicted post-EVL prognosis well. For patients without hepatocellular carcinoma, CLIF-SOFA score ≥6 suggests higher 6-week mortality and CLIF-SOFA score ≥7 suggests higher hospital mortality. For patients with hepatocellular carcinoma, CLIF-SOFA score ≥7 suggests higher 6-week and hospital mortality.

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Section: Discussionsupporting

confidence: 92%

Application of chronic liver failure-sequential organ failure assessment score for the predication of mortality after esophageal variceal hemorrhage post endoscopic ligation

Wong¹,

Chen²,

Chen³

et al. 2017

PLoS ONE

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“…The number of endoscopy sessions required to achieve variceal eradication has varied considerably within reported series and between centers (Table 5 ). A number of studies, including a meta-analysis by Ko et al[ 18 , 38 - 42 ] indicated that EVL achieved variceal eradication rates between 79% and 100%. While there is some evidence to suggest that the methodology and technique of EVL might affect the number of sessions necessary to achieve obliteration, this alone does not explain the substantial differences found between patients.…”

Section: Discussionmentioning

confidence: 99%

Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

Jonas

Kotze

Kloppers

et al. 2020

WJGE

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BACKGROUND Bleeding esophageal varices (BEV) is a potentially life-threatening complication in patients with portal hypertension with mortality rates as high as 25% within six weeks of the index variceal bleed. After control of the initial bleeding episode patients should enter a long-term surveillance program with endoscopic intervention combined with non-selective β-blockers to prevent further bleeding and eradicate EV. AIM To assess the efficacy of endoscopic variceal ligation (EVL) in controlling acute variceal bleeding, preventing variceal recurrence and rebleeding and achieving complete eradication of esophageal varices (EV) in patients who present with BEV. METHODS A prospectively documented single-center database was used to retrospectively identify all patients with BEV who were treated with EVL between 2000 and 2018. Control of acute bleeding, variceal recurrence, rebleeding, eradication and survival were analyzed using Baveno assessment criteria. RESULTS One hundred and forty patients (100 men, 40 women; mean age 50 years; range, 21–84 years; Child-Pugh grade A = 32; B = 48; C = 60) underwent 160 emergency and 298 elective EVL interventions during a total of 928 endoscopy sessions. One hundred and fourteen (81%) of the 140 patients had variceal bleeding that was effectively controlled during the index banding procedure and never bled again from EV, while 26 (19%) patients had complicated and refractory variceal bleeding. EVL controlled the acute sentinel variceal bleed during the first endoscopic intervention in 134 of 140 patients (95.7%). Six patients required balloon tamponade for control and 4 other patients rebled in hospital. Overall 5-d endoscopic failure to control variceal bleeding was 7.1% ( n = 10) and four patients required a salvage transjugular intrahepatic portosystemic shunt. Index admission mortality was 14.2% ( n = 20). EV were completely eradicated in 50 of 111 patients (45%) who survived > 3 mo of whom 31 recurred and 3 rebled. Sixteen (13.3%) of 120 surviving patients subsequently had 21 EV rebleeding episodes and 10 patients bled from other sources after discharge from hospital. Overall rebleeding from all sources after 2 years was 21.7% ( n = 26). Sixty-nine (49.3%) of the 140 patients died, mainly due to liver failure ( n = 46) during follow-up. Cumulative survival for the 140 patients was 71.4% at 1 year, 65% at 3 years, 60% at 5 years and 52.1% at 10 years. CONCLUSION EVL was highly effective in controlling the sentinel variceal bleed with an overall 5-day failure to control bleeding of 7.1%. Although repeated EVL achieved complete variceal eradication in less than half of patients with BEV, of whom 62% recurred, there was a significant reduction in subsequent rebleeding.

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“…10 mmHg, are at risk of developing gastroesophageal varices. Despite improvements in diagnostics and therapy over the last decades, variceal bleeding still is life-threatening with a 6-week mortality of 10-20% [2,12,13]. In this regard, recent studies indicate that transient elastography is a promising non-invasive screening method for detecting decompensated PH, suggesting a direct positive correlation between spleen and liver stiffness and esophageal variceal bleeding [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Five patients were male (56%). The mean Child-Pugh Score at the time of spleen embolization was 5.9 ± 1.3 [5][6][7][8] points, the mean MELD-Score 8.9 ± 2.6 [6][7][8][9][10][11][12][13][14]. All patients had splenomegaly with a mean spleen diameter of 16.6 ± 2.8 [13.3-22.3] cm.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

Buechter

Kahraman

Manka

et al. 2017

72. Jahrestagung Der Deutschen Gesellschaft Für Gastroenterologie, Verdauungs- Und Stoffwechselkrankheiten Mit Sektion Endoskop

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Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long‐term cohort study

Cited by 22 publications

References 20 publications

Application of chronic liver failure-sequential organ failure assessment score for the predication of mortality after esophageal variceal hemorrhage post endoscopic ligation

Application of chronic liver failure-sequential organ failure assessment score for the predication of mortality after esophageal variceal hemorrhage post endoscopic ligation

Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

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