Variceal band ligation: Do more bands improve the outcome in acute bleeding?

Endoscopic variceal band ligation is an effective and safe treatment for acute esophageal variceal bleeding. AIM: To determine if the number of bands placed for acute esophageal variceal bleeding influences early rebleeding. METHODS: The Bleeding Team Data Base, which has been created to prospectively collect information on all patients in our institution with GI hemorrhage, was used to identify cases of acute bleeding from esophageal varices between 1991 and 1996. The following data were abstracted from medical records: demographic variables, clinical presentation, underlying disease, prior therapy for portal hypertension, pharmacotherapy, hospital course, outcome, and endoscopic findings and therapy. Pre-established criteria were used to define rebleeding. Sclerotherapy patients were excluded. The end point of our study was rebleeding at 2 weeks. Standard statistical methods were used for analysis. RESULTS: A total of 127 patients were identified. Etiology of liver disease was alcoholic cirrhosis in 47 (37%) and viral hepatitis in 20 (16%). Varices were categorized as esophageal in 38% and esophagogastric in 62%. Mean number of bands placed at the index bleeding were 5 (1-14 bands). At 2 weeks, 38 patients had recurrent variceal bleeding. Results are shown in the table. Variable Early rebleed (< 2 wks) No rebleeding (2 wks) P N 38 89 Age (yrs) 57±13 56±15 NS Sex (M:F) 24:14 57:32 NS Mean bands 4.2±1.8 5.6±2.7 0.003 Large varices (%) 38 (100) 74 (83) 0.007 Stigmata of bleeding 35 (92) 60 (67) 0.003 Child's class B/C (%) 28 (74) 48 (54) 0.038 On beta-blocker (%) 24 (63) 41 (46) 0.08 In a multiple logistic regression analysis, two variables were found to predict rebleeding at 2 weeks (1) < 5 bands at index bleed and (2) large varices. SUMMARY: Patients who received <5 bands during initial endoscopy for acute variceal bleeding had a higher risk of rebleeding at 2 weeks. CONCLUSIONS: Number of bands placed during endoscopic treatment of acute variceal bleeding is an independent predictor of early rebleeding. This finding has major implications in the management and prognosis of acute variceal bleeding.