Endoscopic variceal ligation-induced ulcer bleeding: incidence by indication, real-world treatment, and outcomes.
Semi-elective variceal ligation is associated with 45-fold higher odds of ulcer bleeding
Endoscopic variceal ligation-induced ulcer bleeding: incidence by indication, real-world treatment, and outcomes.
Endoscopic variceal ligation (endoscopic variceal ligation) - induced ulcer bleeding is a rare but potentially life-threatening complication.
We conducted a retrospective cohort study analyzing all ligation procedures performed in adults with portal hypertension and esophageal varices at Charité University Hospital, Campus Virchow and Campus Mitte, from 01/01/2016 until 06/30/2023.
Semi-elective ligation carried about 45 times the odds of causing ulcer bleeding versus elective procedures
Incidence varied significantly by indication: 0.44% after elective, 8.5% after emergency and 15.9% after semi-elective endoscopic variceal ligation.
Repeat ligation was the most common endoscopic treatment (32.4%), followed by fibrin glue (14.7%) and balloon tamponade (11.7%); the overall primary hemostasis rate was 82.8%.
The 5-day rebleeding rate was 25% and the 6-week mortality rate 41.7%.
Multivariate logistic regression analysis revealed that 5-day rebleeding (OR: 8.05; 1.66-39.2; p = 0.01) and post-bleeding sepsis (OR 7.27; 1.15-45.73; p = 0.035) were strongly associated with 6-week mortality.
Semi-elective endoscopic variceal ligation carries 45-fold higher odds for endoscopic variceal ligation-induced ulcer bleeding.
Endoscopic hemostasis is achievable, but early rebleeding and post-bleeding sepsis drive mortality, suggesting that considering early TIPS in high-risk patients and preventing sepsis deserve more attention.