Haemostasis for variceal bleeding in patients with liver cirrhosis

Abstract

Introduction: Variceal bleeding is a severe complication of cirrhosis leading to significant morbidity and mortality. Ruptured esophageal varices cause approximately 70% of all upper gastrointestinal hemorrhages in cirrhosis. Diagnostic and therapeutic developments have led to a significant improvement in the prognosis of this complication over the past two decades. Endoscopic treatment, mainly variceal band ligation or sclerotherapy, has proved to be effective in controlling acute variceal bleeding. Material and methods: The study was performed within the National Scientific Practical Center of Emergency Medicine. Fifty seven consecutive alive patients admitted with variceal bleeding were included. There were 38 male and 19 female patients, mean age - 53.7±12.6 (95% Cl: 50.34-56.99) years. The patients were divided according to the Child Pugh score as follows: class A - 22 patients (38.6%), class B - 30 patients (52.6%), class C - 5 patients (8.8%). Haemostatic methods used were: Sengstaken Blakemore (SB) tube in 11 patients (19.3%); endoscopic rubber band ligation (EBL) in 23 patients (40.3%) and combined methods - SB probe + EBL in 11 pts (19.3%), Danis stent + EBL in lpt (1.75%), sclerotherapy + SB probe + EBL in 1 pt (1.75%), SB probe + Danis stent + EBL in lpt (1.75%); in nine patients only pharmacological methods of haemostasis were used. Results: Several parameters were analyzed and compared between the groups Child Pugh A, B and C (using one way ANOVA with Bonferroni post test): length of stay, length of ICU stay, Algover shock index, number of installed rubber bands, volume of packed red blood cells and fresh frozen plasma transfusion, length of SB probe in situ and the MELD score. No statistically significant differences were found between the three groups, except the MELD score (A vs B, A vs C and B vs C; PO.OOOl). Conclusion: Although our study didn't show any statistically significant difference of various parameters between the three groups, there is a general agreement that advancing through the Child classes from A to C the patients are more severely ill and have a poorer prognosis, fact proved by the highly significant difference of the MELD scores.