Background and study aims: Variceal bleeding is a severe complication in patients with portal
hypertension. Early rebleeding occurs frequently in the first few weeks after band ligation, and the
mortality associated with each bleeding episode ranges from 30% to 50%. Our aims were to study the rate
of early rebleeding oesophageal varices after band ligation in the Sohag University Hospital, Egypt, and to
assess different clinical, biochemical, ultrasonographic, and endoscopic parameters that may predict the
risk factors of rebleeding.
Patients and methods: In the period from December 2011 to December 2012, we performed endoscopic
variceal ligation (EVL) for 146 cirrhotic patients (105 male and 41 female) with a mean age of
51.77 ± 10.47 years; the patients were divided into rebleeding and non-rebleeding groups. Complete
history taking, clinical examination, laboratory investigations, abdominal ultrasound (US), and upper
gastrointestinal (GI) endoscopy were performed for all patients.
Results: The incidence of early rebleeding after EVL was 20.54%, and it was significantly associated with
male gender (p = 0.013), older age (p = 0.009), infection with spontaneous bacterial peritonitis (SBP)
(p < 0.0007), reduced liver size (p = 0.017), a coarser echo pattern (p = 0.03), the presence of hepatic
focal lesions (p < 0.001), splenomegaly (p = 0.02), the presence of portosystemic collaterals (p = 0.006),
a low haemoglobin (HB) level (p < 0.0001), prothrombin concentration (p = 0.017), high aspartate
aminotransferase (AST) level (p = 0.01), Child–Pugh B and C (p = 0.02, 0.003), large oesophageal varices
F3 in the two endoscopies (p = 0.002; p < 0.0001), varices extending to the superior third Ls (p < 0.001),
and the presence of massive red colour signs (RC+++) (p < 0.0001). By multivariate analysis, SBP and
low HB level were found to be independent predictors of rebleeding.
Conclusion: The following conclusions were drawn from this study: (1) The incidence of rebleeding after
EVL in our centre is about 20%. (2) Early rebleeding after EVL is affected by many clinical, laboratory,
ultrasonographic, and endoscopic parameters. The most prominent of them are SBP, splenomegaly, the
presence of collaterals, anaemia, more decompensated cirrhosis, and the presence of large varices with
red signs. (3) SBP and low HB level were found to be independent predictors of rebleeding.
2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.