Variceal bleeding in cirrhotic patients: risk factors, evolution, treatment
Abstract
Objectives. The aim of this study was to monitor the risk factors that trigger
variceal bleeding in cirrhotic patients, assess the severity of the bleeding and the
efficacy of the endoscopic hemostasis techniques, as well as the recurrence of bleeding
episodes and the mortality rate.
Materials and Methods. The current study was a prospective one, and it was
conducted in the period November 2004 - December 2006 in the “O. Fodor” Regional
Institute of Gastroenterology and Hepatology, Cluj-Napoca.
It included 273 patients with upper gastrointestinal bleeding because of variceal
rupture, assessed by emergency endoscopy. The patients included in the study met the
clinical, biochemical, endoscopic and ultrasound criteria for liver cirrhosis. Its etiology
and staging were documented from the patients’ observation charts.
Results. Out of the 273 cases of variceal bleeding there were 255 (93.4%) cases of
bleeding from esophageal varices and 18 (6.6%) from gastric varices. Variceal bleeding
episodes were more frequent in patients with alcoholic liver cirrhosis (51.28%). Most
patients with variceal bleeding were in Child class B or C (77%). Mortality because
of variceal hemorrhage was 2.93% in the study group. A number of 148 patients were
treated by sclerotherapy and 125 patients with elastic ligatures. Bleeding relapses
occurred in 65 (23.8%) patients within the study group, 43 men and 22 women. Variceal
bleeding relapses were more frequent after sclerotherapy than after elastic ligatures.
Conclusions. Variceal bleeding occurred more frequently in patients with
alcoholic cirrhosis stage Child C. In the current study mortality was relatively low. The
treatment of bleeding recurrence is more difficult, hence variceal rupture prevention
and application of elastic ligatures represent a therapeutic necessity.
variceal bleeding in cirrhotic patients, assess the severity of the bleeding and the
efficacy of the endoscopic hemostasis techniques, as well as the recurrence of bleeding
episodes and the mortality rate.
Materials and Methods. The current study was a prospective one, and it was
conducted in the period November 2004 - December 2006 in the “O. Fodor” Regional
Institute of Gastroenterology and Hepatology, Cluj-Napoca.
It included 273 patients with upper gastrointestinal bleeding because of variceal
rupture, assessed by emergency endoscopy. The patients included in the study met the
clinical, biochemical, endoscopic and ultrasound criteria for liver cirrhosis. Its etiology
and staging were documented from the patients’ observation charts.
Results. Out of the 273 cases of variceal bleeding there were 255 (93.4%) cases of
bleeding from esophageal varices and 18 (6.6%) from gastric varices. Variceal bleeding
episodes were more frequent in patients with alcoholic liver cirrhosis (51.28%). Most
patients with variceal bleeding were in Child class B or C (77%). Mortality because
of variceal hemorrhage was 2.93% in the study group. A number of 148 patients were
treated by sclerotherapy and 125 patients with elastic ligatures. Bleeding relapses
occurred in 65 (23.8%) patients within the study group, 43 men and 22 women. Variceal
bleeding relapses were more frequent after sclerotherapy than after elastic ligatures.
Conclusions. Variceal bleeding occurred more frequently in patients with
alcoholic cirrhosis stage Child C. In the current study mortality was relatively low. The
treatment of bleeding recurrence is more difficult, hence variceal rupture prevention
and application of elastic ligatures represent a therapeutic necessity.
Keywords
cirrhosis, variceal bleeding, sclerotherapy, elastic ligatures, bleeding relapse