PREDICTORS OF VARICEAL BLEEDING AFTER ESOPHAGEAL VARICES BAND LIGATION IN EGYPTIAN CIRRHOTIC PATIENTS

ABSTRACT Background : Bleeding from oesophageal varices is a severe complication of portal hypertension. Endoscopic variceal ligation (EVL) is the treatment of choice for acute variceal bleeding. It is also performed for primary and secondary prophylaxis of bleeding from oesophageal varices. After Endoscopic Band Ligation (EBL), patients are at risk of post-interventional bleeding; the risk factors for this complication are poorly evaluated . The aim of this work : was to evaluate the risk factors for predicting variceal bleeding after elective endoscopic variceal ligation (EVL). Patients and Methods: This study will be carried out in Zagazig University Hospital and El-Galaa Family Military Hospital. The patients was subjected to different demographic, clinical, biochemical, ultrasonographic and endoscopic findings. Results : The incidence of bleeding after elective EVL was 6%. The results showed significant differences between the bleeders and non bleeders regards the severity of liver disease measured by Child-Pugh score , the platelets count, hemoglobin level, prothrombin time , the liver regards its ( size, echogenicity, irregularity of the surface, presence of HFL and Portosystemic collaterals ) , the size and extension of varices. Conclusion: For prediction of variceal bleeding after elective EVL; We can rely on many characteristics, such as age, gender, liver function, severity of varices, number of rubber bands, and so forth. But as demonstrated by the multivariate analysis, there were only four independent risk factors among these, namely moderate to excessive ascites, PT > 18, number of rubber bands placed, size and extent of varices. These four risk factors may therefore be more meaningful than the others for predicting the occurrence of bleeding following elective EVL.