Aim: To summarize the experience in the treatment of esophageal variceal bleeding
Determine risk factors for 6-week mortality and re-bleeding within 5 days in patients with cirrhosis and acute variceal haemorrhage (AVH). Patients and Methods: Reseach times: 09/2009-09/2014. Retrospect analysis was made in 659 patents with esophagogastric variceal bleeding (EVB). Successful hemostasis and risk factors were retrospectively reviewed. Results: The average age: 49,3 : 5,2 (ranged from 13 to 87 years old). Bleeding episode ranged from 1 to 11 times, with an average of 2,5: 1.7. Uver function: Child A: 307, Child B: 243, Child C: 109. Endoscopic grading of esophageal vaicres (grade II and III): 592 patients and isolated gastric varices (IGV2): 67 patients. Treatment: Endoscopic variceal ligation (EVL) was performed in 496 cases and hemostasis was achieved in: 478/496 case (96,3 percent). Histoacryl injection was performed in 67 cases of isolated gastric varices and hemostasis was achieved in 66/67 case (98,5 percent). Transjugular intrahepatic portosystemic shunts (TIPS) was performed in 96 cases and hemostasis was achieved in 88/96 (91,7 percent) case and inddence of hepatic encephalopathy (HE) occurred in 35 of 95 (36,4 percent) patients. Risk factors: Thirty one patients (4,7 percent) died within 6 weeks of acute variceal haemorrhage (AVH). Patients with AVH and MELD score or = 18, requiring or = 4 units of PRBSs within the first 24 h or with active bleeding at endoscopy are at increased risk of dying within 6 weeks. Re-bleeding within 5 days occurred in 35/659 (5,3 percent)
MELD score or = 18 is also a strong predictor of variceal re-bleeding within the first 5 days. Conclusion: Only the Model for End-stage Uver Disease (MELD) score and ullits of packed red blood cells (PRBCs) transfused in the first 24 h were associated with 6 week mortality univariately.