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Abstract
We intended to study different demographic, clinical, biochemical, ultrasonographic and endoscopic variables that can predict or associate with recurrence of variceal bleeding after successful endoscopic treatment of the first attack of variceal bleeding. To fulfill our aim we included one hundred patient presented to the Central Endoscopy Unit of Ain shams University Hospitals during the period from May 2005 to March 2006 .They presented by upper GIT bleeding in the form of hematemesis and /or melena.
All patients, after successful endoscopic treatment of first attack of bleeding, are subjected to three months follow up for recurrence of variceal bleeding. For all patients, complete history taking, clinical examination, routine laboratory investigations, liver function tests, serological examination for screening of etiology of chronic liver disease, abdominal ultrasonography and upper GIT endoscopy were done.
Sixty patients developed recurrent variceal bleeding (group I). Of which twenty five patients (41.67%) rebleed during the first week (very early recurrence), fifteen patients (25%) rebleed during the period from (2-6) weeks (early recurrence) and twenty patient (33.3%) rebleed during the period from (7-12) weeks (late recurrence). Forty patients did not rebleed during the three months of follow up (group II).Comparison was done between both groups to study the parameters that can predict or associate with recurrence of variceal bleeding. Our results revealed that presence of edema, melena, encephalopathy, decreased platelets count, anemia at emergency endoscopy (indicative of the severity of the index bleeding), low serum albumin, high Child-Pugh score, presence of cherry red spots, active variceal bleeding and high grade of varices are highly significant predictors of recurrence of variceal bleeding (P =0.000).
Increased bilirubine level, prolonged prothrombine time, splenomegally, presence of ascites, gastric varices and portal hypertensive gastropathy are significant predictors of recurrence of variceal bleeding (P <0.05). Our results also revealed that age, DM, hypertension, AST level, ALT, level, WBCS count, etiology of chronic liver disease (HBSAg; HCV-Ab; schistosomiasis) liver size and portal vein patency are not predictors of recurrence of variceal bleeding. We also found a positive correlation between presence of edema, melena, encephalopathy, Child-Pugh score, hyperbilirubinemia, prolonged prothrombine time, portal vein diameter, grade of esophageal varices presence of cherry red spots, gastric varices, portal hypertensive gastropathy, and active variceal bleeding at emergency endoscopy on one hand and recurrent variceal bleeding on the other hand. Also we found a negative correlation between hemoglobin level, platelets count, and serum albumin on one hand and recurrent variceal bleeding on the other hand.