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. 2007 Feb;21(2):85-90.
doi: 10.1155/2007/296435.

An assessment of endoscopic and concomitant management of acute variceal bleeding at a tertiary care centre

H Singh  1 , L E Targownik, G Ward, G Y Minuk, C N Bernstein
Affiliations

An assessment of endoscopic and concomitant management of acute variceal bleeding at a tertiary care centre

H Singh et al. Can J Gastroenterol. 2007 Feb.

Abstract
in English, French

Background: Several therapies have been demonstrated to be beneficial in the management of acute variceal bleeding (AVB). The aim of the present study was to characterize the use of these therapies at a Canadian tertiary care centre.

Patients and methods: A comprehensive chart review was performed to assess the management of all adult cirrhotic patients with AVB who were admitted to a university-affiliated, tertiary care centre between April 2001 and March 2004.

Results: A total of 81 AVB patients were identified with a mean age of 53.7+/-13.2 years and a median model for end-stage liver disease score of 14. Endoscopy was performed within 8.2+/-7.6 h of admission. Variceal banding was performed for 87% of patients with esophageal varices, which were the most common source of bleeding (80%). Octreotide was used in 82% of patients for a mean duration of 74.3+/-35.4 h; prophylactic antibiotics were used in 25% of patients and beta-blockers were used in 24% of patients without any contraindications. Follow-up endoscopy was arranged for 46 of 71 (65%) survivors. Prophylactic antibiotic use was associated with the presence of ascites, while beta-blockers were used more often in the last year of the study.

Conclusions: There is a disconnection between the use of evidence-based recommendations and routine clinical practices in the management of AVB. Deficiencies identified include the lack of use of prophylactic antibiotics and beta-blockers, variable use of octreotide and inadequate follow-up recommendations. There is a need to identify measures to improve the process of care for patients with AVB which would ensure optimal management of these patients.

HISTORIQUE :: Plusieurs traitements se sont révélés bénéfiques pour la prise en charge de l’hémorragie variqueuse aiguë (HVA). Le but de la présente étude était de déterminer l’emploi de ces traitements dans un centre de soins tertiaires canadien.

PATIENTS ET MÉTHODE :: Une analyse complète des dossiers a été effectuée afin de vérifier quelle a été la prise en charge des patients cirrhotiques adultes souffrant d’HVA admis dans un centre universitaire de soins tertiaires entre avril 2001 et mars 2004.

RÉSULTATS :: En tout, 81 patients atteints de HVA ont été identifiés. Ils étaient en moyenne âgés de 53,7 ± 13,2 ans et présentaient un modèle médian d’indice de maladie hépatique terminale de 14. L’endoscopie a été pratiquée dans les 8,2 ± 7,6 h suivant l’admission. Un traitement du saignement variqueux a été appliqué chez 87 % des patients qui présentaient des varices œsophagiennes, source principale de l’hémorragie (80 %). De l’octréotide a été administré à 82 % des patients pendant une durée moyenne de 74,3 ± 35,4 h, une antibioprophylaxie a été administrée à 25 % des patients et des bêta-bloquants à 24 % de ceux qui ne présentaient pas de contre-indications. L’endoscopie de suivi a été planifiée chez 46 des 71 survivants (65 %). L’antibioprophylaxie a été associée à la présence d’ascite, tandis que les bêta-bloquants étaient utilisés davantage au cours de la dernière année de l’étude.

CONCLUSION :: On constate un écart entre les recommandations fondées sur des preuves et la pratique clinique lors de la prise en charge concrète de l’HVA. Les lacunes identifiées sont : le recours insuffisant à l’antibioprophylaxie et aux bêta-bloquants, l’utilisation variable de l’oc-tréotide et un suivi inadéquat. Des mesures s’imposent pour ajuster les soins dispensés aux patients souffrant d’HVA de manière à optimiser globalement leur prise en charge.

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Figures

Figure 1)
Figure 1)
Sites of bleeding varices
Figure 2)
Figure 2)
Specialty of the physician with whom the patients were asked to follow up at discharge for the care of portal hypertension. GI Gastroenterology; LAMA Left against medical advice
See this image and copyright information in PMC

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