Clinical outcomes of sedation during emergency endoscopic band ligation for variceal bleeding: Multicenter cohort study

Abstract

Background and Aims Few studies have directly compared the efficacy of sedated‐ and un‐sedated endoscopic variceal ligation (EVL) for acute variceal bleeding. We aimed to determine whether sedation during EVL in patients with variceal bleeding is safe and effective. Methods We analyzed data from patients who underwent EVL for acute variceal bleeding according to sedation in six hospitals of Hallym University Medical Center. The primary endpoint was treatment failure, defined as a failure to control bleeding, death during EVL, or rebleeding within 5 days. Secondary endpoints included the procedure time, adverse events, and 30‐day mortality. Results Of 1,300 patients who were included, only 430 (33.1%) received sedation during EVL. Propofol alone was used for sedation in 85% of sedated‐EVLs. The mean procedure time in the sedation group was shorter than that of the non‐sedation group (12.4 ± 9.5 min versus 13.8 ± 9.4 min, P = 0.010). The proportion of treatment failure did not differ between the groups (7.4% versus 9.1%, P = 0.374). In the multivariable analysis, an AIMS65 score ≥2 and blood transfusion within 72 hours were associated with treatment failure of EVL; however, the use of sedation was not (odds ratio [95% confidence interval (CI)] = 0.96 [0.60–1.51]). Adverse events during EVL and hepatic encephalopathy did not differ between the two groups. Sedation also did not affect the 30‐day mortality (hazard ratio [95% CI] = 0.99 [0.66–1.47]). Conclusion Sedation reduced the procedure time of EVL. Sedation is safe to use during EVL for variceal bleeding in patients with cirrhosis.

Safety and Efficacy of Sedation During Emergency Endoscopy for Upper Gastrointestinal Bleeding: A Propensity Score Matching Analysis

“…The incidence of adverse events (16.5% versus 15.8%; P = 1.00) and 30-day mortality (7.9% versus 5.9%; P = 0.70) were comparable between the two groups outside the propensity score matching analysis. In addition, the incidence of these adverse events was similar to that in some previous reports [26,40,41]. Therefore, we believe that sedatives can be safely used during emergency endoscopy for UGIB.…”

“…The present study focused on whether sedatives are safe and effective when administered during emergency endoscopy in patients with UGIB. Some cohort studies reported the safety of sedation during emergency gastrointestinal endoscopy for variceal bleeding or peptic ulcers, respectively [21,26]. In practice, however, the source of bleeding, whether variceal or nonvariceal, is not known at the time when sedation is initiated.…”

“…(1) follow-up endoscopy identified recurrent UGIB or the stigmata of recent hemorrhage within 30 days or (2) melena and progressive anemia with a decrease in hemoglobin level greater than 2 g/dL and/or with a decrease in systolic blood pressure < 80 mmHg. The procedure time was defined as the time interval between insertion and removal of the endoscope [25,26].…”

“…Endoscopic hemostasis was performed mainly by highfrequency soft coagulation, hemoclipping, or endoscopic variceal ligation (EVL) [26,[28][29][30]. The choice of procedure was at the endoscopists' discretion.…”

Validation of AIMS65 to predict outcomes in acute variceal bleeding: Which risk scoring system outperforms in real practice?

“…In particular, urgent endoscopic therapies with sustainable general conditions, and hopefully under sedation for prompt and secure performance, are representative of endoscopic variceal ligation with readily available banding devices. 5 Various risk scoring systems have been used to predict clinical outcomes in patients with UGIB. 1,2 Most are cumbersome, require multiple variables including endoscopic appearances, and cannot be applied in the earlier stages, especially in emergent settings.…”