Centenary of the UCT Faculty of Health Sciences

Outcome in decompensated alcoholic cirrhotic patients with acute variceal bleeding

Jake E J Krige, Urda K Kotze, Rauf Sayed, Sean Burmeister, Marc Bernon, Galya Chinnery

Abstract


Background. Variceal bleeding (VB) is the leading cause of death in cirrhotic patients with oesophageal varices. We evaluated the efficacy of emergency endoscopic intervention in controlling acute variceal bleeding and preventing rebleeding and death during the index hospital admission in a large cohort of consecutively treated alcoholic cirrhotic patients after a first variceal bleed.
Methods. From January 1984 to August 2011, 448 alcoholic cirrhotic patients (349 men, 99 women; median age 50 years) with VB underwent endoscopic treatments (556 emergency, 249 elective) during the index hospital admission. Endoscopic control of initial bleeding, variceal rebleeding and survival after the first hospital admission were recorded.
Results. Endoscopic intervention alone controlled VB in 394 patients (87.9%); 54 also required balloon tamponade. Within 24 hours 15 patients rebled; after 24 hours 61 (17%, n=76) rebled; and 93 (20.8%) died in hospital. No Child-Pugh (C-P) grade A patients died, while 16 grade B and 77 grade C patients died. Mortality increased exponentially as the C-P score increased, reaching 80% when the C-P score exceeded 13.
Conclusion. Despite initial control of variceal haemorrhage, 1 in 6 patients (17%) rebled during the first hospital admission. Survival (79.2%) was influenced by the severity of liver failure, with most deaths occurring in C-P grade C patients.

Authors' affiliations

Jake E J Krige, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town

Urda K Kotze, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town

Rauf Sayed, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town

Sean Burmeister, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town

Marc Bernon, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town

Galya Chinnery, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town

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Keywords

oesophageal varices; bleeding; endoscopy; survival

Cite this article

South African Medical Journal 2012;102(6):554-557.

Article History

Date submitted: 2011-11-28
Date published: 2012-05-23

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