Introduction:

Variceal hemorrhage (VH) is the most direct complication of portal hypertension with a mortality between 10-20% at 6 weeks. The main objective of timely endoscopic therapy (≤12 hrs.) is the control of bleeding to prevent early recurrence and mortality at 6 weeks, which is considered according to BAVENO VI consensus the primary objective of treatment, determining itself as additional assessment objectives the use of salvage therapy, the transfusion requirements and length of stay.

Objective:

To evaluate the efficacy of timely endoscopic therapy in patients with acute VH and its impact on the additional objectives determined by the consensus of BAVENO VI.

Material and method:

A descriptive, observational, retrospective study carried out during January to December 2018 in patients with acute VH who underwent endoscopy and endoscopic variceal banding (EVB) in the Gastrointestinal Endoscopy service of the Hospital Juarez de México. The primary outcome was mortality at 6 weeks. We analyzed their age, gender, etiology of portal hypertension, timely endoscopy and EVB, the need for salvage therapy, recurrence of bleeding, transfusion requirements and length of stay (LOS). The stage of the disease was determined using the Child Pugh scale.

Results:

We included 88 patients, 35 women and 53 men (39.77% and 60.22% respectively), average age of 54.64 years, the most frequent etiology was liver cirrhosis due to alcohol (52.27%), most of the patients were Child Pugh B (63.63%). Early endoscopy was performed in 52 patients (59.09%) and EVB ≤12 hrs. in 35 patients (39.77%). Mortality at 6 weeks was 9.1%. Early recurrence of VH was presented by 12 patients (15%). Two patients (2.27%) required salvage therapy. Mean transfusion requirement 1.31 ± 1.55 CE. Mean LOS 3.88 ± 2.98. When comparing LVE ≤12 hrs. vs LVE> 12 hrs. mortality at 6 weeks was 11.4% vs 7.5% (p 0.398), early recurrence 14.3% vs 13.2% (p 0.772), higher transfusion requirement 5.7% vs 3.8% (p 0.175), LOS 3.57 ± 2.83 vs 4.09 ± 3.09 (p 0.424).

Conclusion:

The effectiveness of the timely endoscopy in our hospital is greater than that reported in the literature. The adherence to the EVB ≤12 hrs. does not modify the mortality and the additional objectives proposed in BAVENO VI.

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