PREDICTIVE FACTORS OF BLEEDING RELATED TO POSTBANDING ULCER FOLLOWING ENDOSCOPIC VARICEAL LIGATION IN CIRRHOTIC PATIENTS: A CASE-CONTROL STUDY

Geoffroy Vanbiervliet (1) , Sarah Giudicelli-Bornard (2) , Thierry Piche (2) , Frédéric Berthier (3) , Eve Gelsi (2) , Jérôme Filippi (2) , Rodolphe Anty (2) , Kamel Arab (2) , Pierre-Michel Huet (2) , Xavier Hebuterne (2) , Albert Tran (2)

1 Endoscopie Digestive
2 Hépato-Gastroentérologie
3 DIM

Background: Life-threatening bleeding due to early spontaneous slippage of rubber bands have been described after variceal ligation in cirrhotic patients. Aims: To determine the predictive factors of this complication in cirrhotic patients. Methods: Among 605 patients, 21 patients (mean age 56.6 ± 13.5 years) developed 23 spontaneous band slippages with bleeding on postbanding ulcer, as confirmed by endoscopy. Cirrhosis was alcoholic in 13 patients (62%), post viral hepatitis in 3 (14%) and from other causes in 5 (24%). A case-control study was performed comparing 17 from these patients who presented the complication after a first ligation with 84 of the 584 controls who underwent first endoscopic variceal ligation without bleeding complication. Results: Bleeding occurred 13.5 days ± 7.3 [2-29] following ligation. Eleven patients died following the bleeding complication (52%). Using a multivariate analysis, previous upper variceal digestive bleeding (OR 12.07, 95%CI [2.3-63.43]), peptic oesophagitis (OR 8.9, 95%CI [1.65-47.8]), high APRI score (OR 1.54, 95%CI [1.11-2.16]) and low prothrombin index (OR 0.54, 95% CI [0.31-0.94]) were independent predictive factors of bleeding. Conclusions: Bleeding related to postbanding ulcer is a rare but severe complication. The proposed predictive factors should be looked for and minimized before variceal ligation.

Mots clés: Medicine

Geoffroy Vanbiervliet, Sarah Giudicelli-Bornard, Thierry Piche, Frédéric Berthier, Eve Gelsi, et al.. PREDICTIVE FACTORS OF BLEEDING RELATED TO POSTBANDING ULCER FOLLOWING ENDOSCOPIC VARICEAL LIGATION IN CIRRHOTIC PATIENTS: A CASE-CONTROL STUDY. Alimentary Pharmacology and Therapeutics, 2010, 32 (2), pp.225. ⟨10.1111/j.1365-2036.2010.04331.x⟩. ⟨hal-00552563⟩