P0220 : JNK signaling activated by platelet-derived growth factor D (PDGF-D) stimulates secretion of vascular endothelial growth factor-C (VEGF-C) by cancer-associated fibroblasts to promote lymphangiogenesis and early metastasization in cholangiocarcinoma

Background and Aims: Prophylactic administration of platelets and fresh frozen plasma (FFP) is recommended in cirrhotic patients with low platelets/prolonged INR and esophageal varices (EV) that are submitted to endoscopic band ligation (EBL); however it is unknown if this measure prevents post-EBL bleeding. In this analysis we evaluated the outcome of patients undergoing EBL and the role of pre-procedure administration of blood products in this setting. Methods: Retrospective analysis of consecutive EBL procedures in patients with cirrhosis and EV performed at Hospital Clinic, Barcelona from 2010 to 2013. FFP and platelet transfusion were administered if INR was >1.5 and/or platelet count <50×109/L. Complications related to post-EBL bleeding and the relationship with administered blood products were recorded. Results: 516 EBL procedures were performed in 231 patients (70% male), etiology: HCV and alcohol (77%), median MELD 12, Child A/B/C (40/45/15%). EBL procedures were performed for primary (127, 25%) or secondary (290, 55%) prophylaxis and for acute variceal bleeding (AVB) (99, 20%). Median procedure per patient was 2 (1–3). Bleeding occurred in 25 procedures (4.8%). Bleeding complications were not different between Child A/B vs. Child C patients (p = 0.5) and occurred independently of cut-off values and FFP/platelet transfusion (Table 1). FFP and platelets were given in 41 (7.9%) and 39 (7.6%) procedures respectively. Multivariate analysis showed that MELD score (OR, 1.1; 95%CI, 1.0–1.2; p < 0.01) and AVB (OR, 3.4; 95%CI, 1.6–7.0;p < 0.01) emerged as a predictive factors for post-EVL bleeding. Conclusions: Pre-procedure administration of FFP and platelets in cirrhotic patients undergoing EBL does not confer a benefit as a prophylactic measure of post-EBL bleeding. Post-EBL bleeding is independent of pre-procedure cut-off values and FFP/platelet administration. MELD score and AVB are risk factors for post-EBL bleeding. Prospective studies are needed to determine the role of routine administration of blood products prior to EBL in patients with cirrhosis.