FREQUENCY OF RE-BLEEDING AFTER SUCCESSFUL ENDOSCOPIC MANAGEMENT OF ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS

In nearly 50% of cirrhotic patients gastroesophageal varices are present at the time of diagnosis. Each episode of esophageal bleeding is associated with 30-70% risk of mortality. Patients treated with EVBL had a decreased risk of first bleeding episode by 64% and mortality by 45%. Objective: To assess the rebleeding rate in 4 weeks after successful endoscopic variceal band ligation in cirrhotics. Methods: The retrospective observational analysis of endoscopic band ligation procedures, performed in Fatima Memorial Hospital, Lahore during the period January 2016-February 2018, was made. 80 endoscopic band ligation procedures were included in the study. Patients with rebleeding were recorded presenting in four weeks. Results: 80 cases with history of cirrhosis and previous band ligation were chosen for the study. Out of which 49 (61.3%) were male and 31 (38.8) were female with median age of 51.32 +/- 12.57. Cause of liver cirrhosis was identified as 63(78.8%), 5(6.3%) and 12(15%) for hepatitis C, hepatitis B and Non B, Non C respectively. Out of 80, 13(16.2%) patients presented with rebleeding in 4 weeks post band ligation. 12(92.3%) out of 13 patients with rebleeding had child pugh class C and had more than 2 columns of esophageal varices. Conclusion: Endoscopic variceal band ligation was found to be an effective modality in reducing the frequency of rebleeding in cirrhotic patients. Re-bleeding after variceal banding was 16.2 %. Major factors contributing to re-bleeding were number of columns of esophageal varices and severity of liver cirrhosis.