Prognostic Factors, Incidence and Management for Acute Variceal Bleeding in the Liver Transplantation Era

Abstract

Background: Gastroesophageal varices are the most common and clinically important part of the portosys-temic collaterals due to their tendency to rupture and cause massive gastrointestinal bleeding. Objective The aim of this work was to evaluate retrospectively the incidence and the factors of prediction for the treatment of bleeding by gastroesophageal varices in the patients attended in the Emergency Room of the Hospital State University of Campinas (Brazil) from the last ten years. Methods: The method used here consisted of a descriptive and retrospective study carried out from the analyses of the medical records of 769 patients with upper gastrointestinal bleeding of which 220 were admitted because of upper gastrointestinal bleeding caused by gastroesophageal varices during this same period. Results: The results showed that the gastroe-sophageal varices appeared in 28.6% of the patients and they were the second most common cause of upper gastrointestinal bleeding. While evaluating factors such as age, sex and the common individual records, it was proved that this disease occurs mainly among people between the third and the fifth decade of life, with the great majority of cases occurring in the fourth decade (29.2%), of which 76.8% were male. There was an association of hematemesis and melena in the admission of 57.7% of the patients and even ascites was a common diagnosis in 48.2% of them. Most of these patients (40%) were classified as Child class B at admis-sion. The early endoscopic exam was used for 96.8% of them and showed the presence of F3 varices in 38.5%, CB varices in 25.1% and RCS varices in 12.6%. Most of these varices (41.5%) were situated in the distal third of the esophagus. The most used pharmacological treatment was based on octreotide in 45.9% of the patients. They received 0.05 mg of intravenous octreotide and a maintenance dose of 1 mg per day in 98.6% of the cases, with efficacy in 74.2% of the patients. The tamponade with Sengstaken-Blakemore tube was applied in 30.5% of the patients, but it was observed that 69.7% of them did not present any consider-able progress and this situation led to their death. The endoscopic treatment was performed in 41.8% of the patients with efficacy in 81.5% of them. The sclerotherapy was used for 60.9% of the studied cases with Ethamolin® being the most used for sclerosing. Emergency surgery was used in just 8.6% of the patients studied and it controlled the bleeding in 78.9% of the cases. Conclusion: We concluded that gastroesophag-eal bleeding was an important cause of upper gastrointestinal hemorrhage, even in the liver transplantation era. Factors of prediction for this bleeding were the endoscopic classification, the presence of ascites and the degree of liver failure, according to the Child-Pugh classification.