Analysis of the risk factors in early rebleeding after endoscopic variceal ligation

Objective To summarize the early rebleeding rate after Endoscopic variceal ligation （EVL） as well as to analyze the risk factors. Methods The records of patients treated with EVL due to cirrhosis and/or hepatocellular carcinoma in the endoscopy center were surveyed. Totally 593 procedures of EVL had been performed in the period between 1992 and 2002. In order to discover independent risk factors, a lot of items were analyzed, including gender, age, coexistent diseases, types of cirrhosis, existence of hepatocellular carcinoma, the history of ligation or shunt operation and/or splenectomy, clinical presentation before and after admission, serum examination and radiology results, endoscopy discription, histologic findings and phamarcotherapy. Results Varices number, serum glucose and α-fetoprotein levels and prothrombin time were independent risk factors of early rebleeding after EVL, P values were 0. 015, 0. 026, 0. 026 and 0. 014 respectively. With increase of the number of varices （4 or more）, serum glucose （ higher than 7.0 mmol/L） and α-fetoprotein levels （ higher than the cut-off value） as well as decrease of prothrombin time activity （ lower than 50% ）, the possibility of early rebleeding after EVL increased, with the OR values of 3. 120, 4. 800, 0. 283, 4. 328, and the 95% CI of 1. 324-7. 335, 1. 662-8. 775, 0. 103-0. 708, 1. 349-13. 883 respectively. Conclusion The early rebleeding rate after EVL is effected by the abnormalities in varices number, serum glucose and α-fetoprotein levels and prothrombin time, effective measures for prevention and treatment should be adopted before EVL. Key words: Esophageal varices;  Endoscopic variceal ligation;  Bleeding ;  Risk factors