Results of the management of upper gastrointestinal bleeding from gastroesophageal varices

Introduction: the management of upper gastrointestinal bleeding caused by r upture of gastric and/or esophageal varices in patients with liver cirrhosi s must focus on the initial control of the haemorrhage avoiding further wor sening of an already poor liver function and the prevention of early relaps ing bleeding. Therapeutic options include endoscopic, pharmacological and s urgical methods. Material and methods: prospective study of the results obtained after the f ollow-up of 90 bleeding episodes in a total of 54 patients, 35 men and 19 w omen, with a mean age of 58 years (range 32-77), to which a therapeutic pro tocol for acute bleeding secondary to portal hypertension was applied over a 22-months period. Patient classification according to Child-Pugh upon adm ission was 57% Child A, 34% Child B and 9% Child C. Results: mean hospital length of stay was 9 days (2-50). Of the 90 bleeding episodes, 15 were early relapsing bleeding episodes (16.7%). Twelve patien ts died (mortality rate of 22.2% by patients and 13.4% by bleeding episodes ). Twelve emergency surgical procedures were performed because of the persi stence of haemorrhage. Forty one per cent of patients were readmitted becau se of relapsing bleeding at least once during the follow-up period. Conclusions: management of upper gastrointestinal bleeding due to gastroeso phageal varices in patients with liver cirrhosis requires a combined therap y in order to attain maximum effectiveness in acute haemorrhagic episodes a nd to address all potential later consequences. Such therapy should be prov ided in a hospital fully equipped and with specialists in this pathology, B ased on our experience, emergency surgery as rescue treatment for persisten t or short-term relapsing bleeding should be restricted to patients with go od hepatic function because of its high morbidity and mortality.