Predictors of early bleeding after endoscopic variceal ligation for esophageal varices: a systematic review and meta-analysis

Abstract

Aim of the study: Endoscopic variceal ligation (EVL) is important for emergency as well as prophylactic management of esophageal varices. Early bleeding after EVL is associated with significant morbidity and mortality. Assessing the likelihood of early post-EVL bleeding and its determinants can help deciding therapeutic strategies for high-risk patients. The aim of the present meta-analysis was to identify predictors of early bleeding after EVL. Material and methods: A comprehensive search of the literature was conducted from 2000 to November 2021 for studies evaluating the incidence, predictors and outcome of post-EVL bleeding. Pooled odds ratios (OR), mean difference (MD) and their 95% confidence intervals (CI) were calculated for prognostic variables. Results: A total of 16 studies with data on 13,378 patients were included in the meta-analysis. Among 34 parameters, 14 parameters were assessed for association with early bleeding after EVL. Lower hemoglobin at admission (MD = 1.11, 95% CI: -1.91 to -0.31), higher MELD score (MD = 2.00, 95% CI: 0.51-3.50), associated gastric varices (OR = 5.99, 95% CI: 1.06-33.90), higher number of bands (MD = 0.49, 95% CI: 0.02-0.97), and peptic esophagitis (OR = 11.38, 95% CI: 1.21-106.81) were significantly associated with increased risk of bleeding. However, there was significant heterogeneity among the studies with respect to all the analyzed parameters. Conclusions: Major predictors for early post-EVL bleeding in cirrhosis are admission hemoglobin level and MELD score, associated gastric varices, number of bands deployed during EVL, and peptic esophagitis on follow-up endoscopy. These risk factors may be useful for risk stratification after EVL in cirrhotics.

The impact of restrictive blood transfusion on the safety of patients with esophageal varices after endoscopic variceal ligation

“…Previous studies have shown that hemoglobin level is an important predictor of early rebleeding after EVL [10,11,22]. As for the impact of blood transfusion on the safety after EVL, this study also further analyzed the impact of RBC transfusion to maintain different postoperative Hb levels (Hb < 70 g/L, 70 g/L ≤ Hb < 90 g/L, and Hb ≥ 90 g/L) on early rebleeding after EVL.…”

Effects of endoscopic variceal ligation on survival in cirrhotic patients

“…Метод эндоскопического лигирования вариксов пищевода (ЭЛ ВРВП), в силу своей минимальной инвазивности, на сегодняшний день получил широкое распространение и рекомендован как наиболее предпочтительный [6]. Обратной стороной ЭЛ, негативно влияющей на выживаемость больных после ОПВК, являются специфичные для метода осложнения, среди которых наиболее опасным является постлигатурное кровотечение, прямо зависимое по частоте развития от числа одномоментно установленных лигатур [7]. Раннее (до 12 часов после эпизода ОПВК) эндоскопическое вмешательство ассоциировано с более высокой частотой рецидива кровотечения [8].…”

Journal of Digestive Endoscopy: Year (2023) in Review

“…28 A technical note on AI on detection and characterization of colorectal polyp further supplemented the above review by a comprehensive explanation of the concept AI. 29 Other reviews published last year worth mentioning include linear endoscopic ultrasound examination of the biliary system and its clinical applications, 30 capsule endoscopy in inflammatory bowel disease, 31 environmentally sustainable endoscopy practices, 32 efficacy of over-the-scope clips compared to standard therapy for nonvariceal upper gastrointestinal bleeding, 33 gastrointestinal subepithelial lesions, 34 pictorial essay depicting linear endoscopic ultrasound examination of pancreas anatomy, 35 application of endobiliary and pancreatic radiofrequency ablations. 36…”