Do number of variceal bands placed at the index bleed predict rebleeding at 6 months?

The rebleeding risk following acute variceal bleeding depends on several variables including Child's class, size of varices and treatment. Endoscopic variceal band ligation (VBL) is an effective and relatively safe method to control acute variceal bleeding. In an earlier study, we had determined that the number of bands placed at index bleed independently predicts early rebleeding (≤2 wks). The AIM of this study was to determine if the number of bands placed during the index bleed was an independent predictor of rebleeding at 6 mos. METHODS: The Bleeding Team Data Base created to prospectively collect information on all pts in our institution with GI hemorrhage, was used to identify cases of acute bleeding from esophageal varices treated with VBL between 1991 and 1996. Candidate variables including age, sex, Child's class, units of blood transfused, prior therapy with beta-blockers, adjuvant emergency pharmcotherapy, co-morbid illnesses, endoscopic findings (size of varices, number of trunks, stigmata of recent bleeding) and number of bands placed (index bands=banding for index bleeding and additional bands=total bands - index bands) were analyzed using multiple logistic regression to determine independent predictors of rebleeding at 6 mos. The 6-month incidence of rebleeding was estimated by the Kaplan-Meier method and the time to rebleed was compared using the log-rank test. RESULTS: A total of 127 pts (81M:46F) had emergency VBL for acute variceal bleeding. At 6 mos, 50 pts (39%) had recurrent variceal bleeding; 7 underwent TIPS and 1 pt had a liver transplantation. Three variables (table) were found to independently predict rebleeding at 6 mos. Variable Estimate (β₁) R² P Index bands <5 1.45 0.11 0.0000 Size (large) 1.4 0.08 0.0001 PRBC (>3 units) 0.57 0.02 0.04 Pts who had received <5 bands during the index bleeding had a 4-fold higher risk of rebleeding during the next 6 mos. Length of follow-up between pts who received <5 and ≥5 bands at index bleed was similar (153±54 days, P=0.8). Time to rebleed was significantly lower in the <5 bands group, log-rank (P<.000). CONCLUSIONS: In our retrospective study, pts with <5 bands placed at the index bleed had a higher risk of rebleeding over the next 6 mos. Future studies should incorporate this variable when assessing the risk of rebleeding.