Ulcer bleeding after band ligation of esophageal varices: Risk factors and prognosis

Dueñas, E.; Cachero, Alba; Amador, Alberto; Rota, R.; Salord, Silvia; Gornals, Joan B.; Xiol, Xavier; Castellote, José

doi:10.1016/j.dld.2019.06.019

Cited by 46 publications

(77 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The largest study to date prospectively collected 24 cases of post-EVL ulcer bleeding of 521 total EGD procedures. 58 Platelet count was similar between the groups (121,000/mL in bleeding subjects vs 118,000/ mL in controls) and prothrombin time/INR was elevated (1.8 in bleeding subjects vs 1.5 in control). Of note, Model for End-Stage Liver Disease was significantly higher in the group that developed post-EVL ulcer bleeding in this study.…”

Section: Resultsmentioning

confidence: 81%

“…A total of 4 studies reported bleeding outcomes in patients undergoing EGD with EVL. 13,[56][57][58] Study designs included case-control, retrospective, and prospective cohort studies. One study examined the risk of bleeding in patients undergoing EVL while on anticoagulation.…”

Section: Resultsmentioning

confidence: 99%

“…Single cohort retrospective studies demonstrate a correlation between bleeding risk and more advanced cirrhosis, independent of platelet count or INR. 38,58 This suggests there may be other factors unique to the individual patient that increase bleeding risk, including ACLF or sepsis. The 2 largest trials comparing TPO agonists with standard platelet transfusion for thrombocytopenia (platelet count <50,000/mL) before procedures included mostly low-risk procedures and found very low bleeding rates.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

AGA Technical Review on Coagulation in Cirrhosis

et al. 2021

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

AGA Technical Review on Coagulation in Cirrhosis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Whilst there are well established guidelines for the management of OV bleeding, EBL-induced ulceration and ectopic varices often present a management challenge. The prevalence of EBL-induced ulcer bleeding is reported to be 3.6-15% [36][37][38] with high mortality rates due to rebleeding, and management is highly variable [39,40]. Ectopic varices can involve any site within the GI tract, most commonly the rectum or duodenum.…”

Section: Discussionmentioning

confidence: 99%

Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience

Gillespie

McAvoy

Yung

et al. 2021

JCM

View full text Add to dashboard Cite

Variceal haemorrhage is a severe complication of liver disease with high mortality. Human recombinant thrombin has gained popularity in the management of variceal haemorrhage. We report on the use of thrombin for gastric and ectopic varices at a regional tertiary care centre. This was a retrospective observational study. Patients with portal hypertension who received endoscopic injection of recombinant thrombin were identified and data collected on haemostasis and rebleeding rates, complications and mortality. Patients were grouped by indication for thrombin injection: gastric/oesophageal/ectopic varices and endoscopic band ligation (EBL)-induced ulceration. 155 patients (96M/59F, mean age 58.3 years) received endoscopic thrombin injection. Mean volume of thrombin injected at index endoscopy was 9.5 ml/2375IU. Initial haemostasis was achieved in 144 patients (92.9%). Rebleeding occurred in a total of 53 patients (36.8%) divided as follows: early rebleeding (<5 days from index endoscopy)—26 patients (18%); rebleeding within 30 days—42 patients (29.1%); delayed rebleeding (> 30 days)—11 patients (7.6%). There was statistically significant difference in rate of initial haemostasis between Child-Pugh A/B patients vs Child-Pugh C (p = 0.046). There was no significant difference in rebleeding rates between different indication groups (p = 0.78), by presence of cirrhosis or by Child-Pugh Score. All-cause mortality at 6 weeks was 18.7%; 1-year mortality 37.4% (median follow-up 48 months). There was no significant difference in mortality between groups (p = 0.37). No significant adverse events or complications were reported. Thrombin is effective and safe for gastric varices and other portal-hypertension-related bleeding including oesophageal varices, ulcers secondary to EBL and ectopic varices.

show abstract

“…An uncontrolled case series of 5 patients undergoing elective VBL on continued warfarin observed no post-banding haemorrhage 191 . Placing no more than 6 bands per session may help reduce the risk of post-banding ulcer haemorrhage 192 . In a large retrospective series, the risk of haemorrhage in patients undergoing variceal banding on DOAC or warfarin was high for both groups at 19.2 % and 25.9 % respectively p = 0.49 39 .…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

et al. 2021

View full text Add to dashboard Cite

This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

show abstract

Ulcer bleeding after band ligation of esophageal varices: Risk factors and prognosis

Cited by 46 publications

References 11 publications

AGA Technical Review on Coagulation in Cirrhosis

AGA Technical Review on Coagulation in Cirrhosis

Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Contact Info

Product

Resources

About