Keung CY, Morgan A, Le ST, Robertson M, Urquhart P, Swan MP. Survival outcomes and predictors of mortality, re-bleeding and complications for acute severe variceal bleeding requiring balloon tamponade. World J Hepatol 2022; 14(8): 1584-1597 [PMID: 36157875 DOI: 10.4254/wjh.v14.i8.1584]
Corresponding Author of This Article
Charlotte Y Keung, FRACP, MBBS, Academic Fellow, Doctor, Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton, Melbourne 3168, Victoria, Australia. charlotte.keung@monashhealth.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Aug 27, 2022; 14(8): 1584-1597 Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1584
Table 1 Baseline characteristics of patients with cirrhosis requiring balloon tamponade for acute severe variceal bleeding comparing death and survival at 6 wk
Table 2 Management of index variceal bleed and characteristics around insertion of Sengstaken-Blakemore tube
Variable
Value (n = 80)
Vasoactive agent
79 (98.8)
Terlipressin
30 (37.5)
Octreotide
49 (61.3
Empiric antibiotics
77 (96.3)
Time to endoscopy from bleed, h
6.8 (4.2, 19.0)
Site of variceal bleed
Oesophageal varices
64 (80.0)
Gastric varices
16 (20.0)
Initial endoscopic therapy
Variceal band ligation
43 (53.8)
Cyanoacrylate injection
2 (2.5)
Indication for SBT insertion
Incomplete haemostasis
54 (67.5)
Poor endoscopic views
41 (51.2)
Approach for SBT insertion (n = 71)
Nasal
22 (31.0)
Oral
49 (69.0)
Confirmation of SBT position
X-ray
44 (55.0)
Direct endoscopic vision
18 (22.5)
No documentation
15 (18.8)
Gastric balloon inflation (n = 76)
Volume, mL
285 (250, 300)
Time inflated, h
26.8 (16.9, 44.7)
Oesophageal balloon inflation (n = 22)
Volume, mL
100 (39, 100)
Time inflated, h
20.5 (10.2, 36.8)
Therapy post-SBT deflation (n = 62)
Repeat endoscopic therapy
27 (43.5)
Further balloon tamponade
16 (20.0)
Table 3 Patient outcomes following Sengstaken-Blakemore Tube insertion
Variable
Value (n = 80)
Length of stay, d
Total hospital LOS
11.0 (7.0, 19.5)
ICU LOS
4.90 (2.3, 9.1)
Duration of mechanical ventilation, h
89.5 (39.3, 153.8)
Blood product transfusion
Packed red cells, units
6 (4, 10)
Platelets, units
1 (0, 3)
Fresh frozen plasma, units
2 (1, 6)
Achieved primary haemostasis
73 (91.3)
Re-bleeding
25 (34.2)
Complications of SBT
19 (34.5)
Mucosal ulceration and tears (without perforation)
17 (89.5)
Aspiration pneumonia
4 (21.0)
Perforation
1 (5.3)
TIPS
Underwent TIPS
17 (21.3)
Time to TIPS from SBT, d
2.95 (1.4, 4.1)
Survival
Survived hospital admission
41 (51.2)
Alive at 6 wk
41 (51.2)
Alive at 26 wk
39 (48.8)
Alive at 52 wk
37 (46.3)
Table 4 Predictors of 6 wk mortality after acute severe variceal bleeding requiring balloon tamponade
Variable (n = 75)
Univariate analysis
Multivariate analysis (n = 68)
OR (95%CI)
P value
OR (95%CI)
P value
Age
0.99 (0.95-1.04)
0.669
-
-
Male sex
1.33 (0.45-3.98)
0.606
-
-
Haemodynamic instability
2.01 (0.75-5.41)
0.167
-
-
INR
8.19 (2.10-31.89)
0.002
-
-
Albumin
0.924 (0.85-1.01)
0.063
-
-
Bilirubin
1.02 (1.01-1.030)
0.009
-
-
Creatinine
1.02 (1.01-1.035)
0.024
-
-
Sodium
0.93 (0.86-0.99)
0.045
-
-
pH
0.02 (0.01-0.68)
0.030
-
-
Lactate
1.16 (1.02-1.31)
0.019
-
-
AIMS65 score
1.96 (1.15-3.35)
0.014
-
-
GBS
0.98 (0.86-1.15)
0.767
Rockall score
1.44 (0.86-2.43)
0.168
Child-Pugh score
1.40 (1.01-1.80)
0.007
-
-
MELD score
1.22 (1.09-1.37)
< 0.001
1.21 (1.06-1.41)
0.006
HCC
6.58 (1.31-32.95)
0.022
11.51 (1.61-82.20)
0.015
Re-bleeding
8.76 (2.77-27.73)
< 0.001
13.06 (3.06- 55.71)
< 0.001
SBT complications
1.40 (0.44-4.51)
0.573
-
-
TIPS performed
0.30 (0.09-1.04)
0.058
-
-
Table 5 Outcomes for patients who re-bled after Sengstaken-Blakemore tube insertion for acute severe variceal bleeding
Variable (n = 73)
No Re-bleeding (n = 48)
Re-bleeding (n = 25)
P value
Duration of mechanical ventilation (h)
86.0 (46.0, 134.5)
138.0 (79.0, 210.0)
0.026
No. of packed RBC transfused
5 (3, 7)
10 (5, 16)
0.001
No. of platelets transfused
1 (0, 2)
1 (0, 4)
0.430
No. of FFP transfused
2 (0, 4)
6 (2, 14)
0.001
6 wk mortality
13 (27.1)
19 (76.0)
< 0.001
Citation: Keung CY, Morgan A, Le ST, Robertson M, Urquhart P, Swan MP. Survival outcomes and predictors of mortality, re-bleeding and complications for acute severe variceal bleeding requiring balloon tamponade. World J Hepatol 2022; 14(8): 1584-1597