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Optimal endoscopy timing according to the severity of underlying liver disease in patients with acute variceal bleeding

2019; Elsevier BV; Volume: 51; Issue: 7 Linguagem: Inglês

10.1016/j.dld.2019.01.013

1878-3562

Cheal Wung Huh, Joon Sung Kim, Da Hyun Jung, Ju Dong Yang, Soon Woo Nam, Jung Hyun Kwon, Byung‐Wook Kim,

Liver Disease Diagnosis and Treatment

Abstract Background Current guidelines recommend endoscopic therapy to be performed within 12 h for acute variceal bleeding (AVB). However, the optimal timing of endoscopic therapy for AVB remains unclear. Aims To examine the relationship between the endoscopy timing and clinical outcomes in AVB, with emphasis on liver function and endoscopy timing. Methods From January 2010 to June 2017, cirrhotic patients with AVB confirmed by endoscopy were evaluated. The primary outcome was a composite of 6-week rebleeding and mortality. We stratified patients according to the MELD score. Results In 411 patients, the overall composite outcome rate was 30.9% (n = 127) at 6 week. Patients who underwent urgent endoscopy (≤12 h) had a significantly higher composite outcome than patients who underwent non-urgent endoscopy (>12 h) (34.4% vs. 19.1%; P = 0.005). Low-risk patients who underwent urgent endoscopy were more likely to reach the composite outcome (adjusted OR, 0.84 per 4 h; 95% CI, 0.73–0.98; P = 0.027). These findings persisted even after adjustment for baseline characteristics between the urgent and non-urgent groups. Conclusions Urgent endoscopy is significantly associated with a poorer outcome in patients with AVB, especially in low-risk patients. Our result provides a treatment strategy according to the severity of underlying liver disease in patients with AVB.