Predicting the risk of early rebleeding following endoscopic variceal ligation in cirrhotic patients with computed tomography

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Abstract Background: Life-threatening rebleeding following endoscopic variceal ligation (EVL) in patients with cirrhosis rarely can occur. The present study aimed to evaluate the performance of computed tomography (CT) in predicting the risk of early rebleeding following EVL in cirrhotic patients. Methods: We retrospectively investigated 285 cirrhotic patients who had undergone EVL. EVL was performed for prophylaxis or acute variceal bleeding. The patients were classified into 2 groups: early rebleeding (< 14days after EVL) and non-early rebleeding. We compared baseline characteristics including CT findings between the patient groups. Results: Among the 285 patients who underwent EVL treatment, 19 patients (6.7%) experienced early rebleeding. On average, these rebleeding oc­curred 9.3 ± 3.5 days after the EVL, with a range of 3 to 13 days. Patients who experience early rebleeding had a higher six-week bleeding-related mortality rate compared to those in the non-early rebleeding group (31.6% vs. 10.2%; p = 0.014). There was a correlation between the grade of esophageal varix observed during endoscopy and the diameter of esophageal varix observed on CT (p < 0.001). The diameter of esophageal varix on CT was identified as the only significant predictive factor for early rebleeding (p = 0.005). Conclusion: A larger esophageal varix diameter observed on CT is associated with an increased risk of early rebleeding after EVL treatment. Early identification of this high-risk group can provide a change of treatment strategies to improve patient outcomes.

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