Introduction. Esophageal varices, hepatic encephalopathy, and ascites are the major complications of liver cirrhosis as a result of portal hypertension. Upper gastrointestinal bleeding (UGIB) from ruptured esophageal varices is the most common cause and represents a major emergency in gastroenterology. The main therapeutic methods are the sclerosis of the varices and the endoscopic variceal ligation with a quite high success rate in centers where they are available. Post-procedural complications can range from mild symptoms, such as chest pain, to severe complications like rebleeding from post-ligation ulcers, aspiration pneumonia and esophageal perforation with the onset of mediastinitis.
Methods. We have retrospectively analyzed a number of 30 patients admitted between January 2016 – December 2016 to the department of Gastroenterology of the Saint Mary’s Clinical Hospital Bucharest with upper gastrointestinal bleeding from ruptured esophageal varices, who were treated either by sclerosis or endoscopic ligation.
Results. From all the 30 patients who were included in this study, all of them have been previously diagnosed with liver cirrhosis. Regarding etiology, alcohol was incriminated in 15 patients (50%), hepatitis C
infection in 9 patients (30%), and hepatitis B infection in 6 patients (20% ). 2 patients belonged to the Child-Pugh A class (6.66%), 10 patients were classified as Child-Pugh B (33.33%) and 18 patients were classified
as Child C (60%). Efficient endoscopic hemostasis (sclerotherapy and ligation) was performed in 28 patients (93.3%). Endoscopic ligation was performed in 26 patients (86%) and sclerotherapy in 4 patients (13.33%). The death occurred in 2 patients (6.66%). Chest pain was the most common complication and affected 14 patients (46.66%). Other adverse events included postligation ulcers – 10 patients (33.33%), transient dysphagia which occurred in 10 patients (33.33%), fever – 2 patients (6.66%), esophageal stricture in 1 patient (3.33%) and aspiration pneumonia in 1 patient (3.33%).
Conclusions. The main therapeutic options of upper gastrointestinal bleeding from ruptured esophageal varices are sclerotherapy and endoscopic ligation, with a success rate of up to 93.3%. Complications of sclerosis and endoscopic ligation are classified as follows: during procedure – aspiration of gastric contents resulting in aspiration pneumonia; immediately post-procedure: chest pain, transient dysphagia, fever that precedes the development of bacterial infections and post-ligation ulcers. Late complications were rare and included esophageal strictures.
Keywords: upper gastrointestinal bleeding, esophageal varices, sclerotherapy, endoscopic ligation.
CESITO Center, “Sfanta Maria“ Clinical Hospital, Bucharest, Romania