TY - JOUR
T1 - Rates of recurrent variceal bleeding are low with modern esophageal banding strategies
T2 - A retrospective cohort study
AU - Branch-Elliman, Westyn
AU - Perumalswami, Ponni
AU - Factor, Stephanie H.
AU - Sled, Sarah M.
AU - Flamm, Steven L.
N1 - Publisher Copyright:
© Informa Healthcare.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Background. Variceal bleeding has a high rate of mortality and recurrence. Endoscopic band ligation (EBL) is the established standard of care for secondary prevention of variceal bleeding. Objective. To determine the long-term re-bleeding rate of an EBL protocol similar to current society guidelines. Design. We conducted a retrospective cohort study at a tertiary care center of all patients with a history of a variceal bleed who underwent an aggressive band ligation protocol. Interventions. At the time of sentinel bleed, all varices, regardless of size, were ligated. EBL was then repeated every 2 weeks until stabilization, and all visible varices were ligated. The interval between banding sessions then increased. Main outcome measurements. The incidence of re-bleeding was calculated as the time between clinical stabilization after the sentinel event until data censoring, which occurred at time of re-bleed, death, transplant or loss-to-follow up. Gastric variceal bleeding was a secondary endpoint. Results. N = 176 patients were treated with aggressive EBL, and followed for a median of 16 months (range, 3 months-6.9 years). The 6 month incidence of re-bleeding was 2.3%, the 12 month incidence was 3.4%, and the 2 year incidence was 4.6%. Overall, aggressive EBL was well-tolerated. One patient died during follow-up secondary to a gastric variceal bleed. Conclusions. Aggressive EBL yields a low rate of re-bleeding when compared to standard practice. Secondary prophylaxis with aggressive EBL should be a consideration for patients following a sentinel bleeding event.
AB - Background. Variceal bleeding has a high rate of mortality and recurrence. Endoscopic band ligation (EBL) is the established standard of care for secondary prevention of variceal bleeding. Objective. To determine the long-term re-bleeding rate of an EBL protocol similar to current society guidelines. Design. We conducted a retrospective cohort study at a tertiary care center of all patients with a history of a variceal bleed who underwent an aggressive band ligation protocol. Interventions. At the time of sentinel bleed, all varices, regardless of size, were ligated. EBL was then repeated every 2 weeks until stabilization, and all visible varices were ligated. The interval between banding sessions then increased. Main outcome measurements. The incidence of re-bleeding was calculated as the time between clinical stabilization after the sentinel event until data censoring, which occurred at time of re-bleed, death, transplant or loss-to-follow up. Gastric variceal bleeding was a secondary endpoint. Results. N = 176 patients were treated with aggressive EBL, and followed for a median of 16 months (range, 3 months-6.9 years). The 6 month incidence of re-bleeding was 2.3%, the 12 month incidence was 3.4%, and the 2 year incidence was 4.6%. Overall, aggressive EBL was well-tolerated. One patient died during follow-up secondary to a gastric variceal bleed. Conclusions. Aggressive EBL yields a low rate of re-bleeding when compared to standard practice. Secondary prophylaxis with aggressive EBL should be a consideration for patients following a sentinel bleeding event.
KW - Band ligation
KW - Secondary prophylaxis
KW - Variceal bleeding
UR - http://www.scopus.com/inward/record.url?scp=84934271362&partnerID=8YFLogxK
U2 - 10.3109/00365521.2015.1027263
DO - 10.3109/00365521.2015.1027263
M3 - Article
C2 - 25865440
AN - SCOPUS:84934271362
SN - 0036-5521
VL - 50
SP - 1059
EP - 1067
JO - Scandinavian Journal of Gastroenterology
JF - Scandinavian Journal of Gastroenterology
IS - 9
ER -