Recurrent Hemorrhage after Esophageal Variceal Ligation: What are the Predictive Factors?

Recurrent hemorrhage after esophageal variceal ligation (EVL) is a severe and potentially life-threatening complication of portal hypertension. Identifying predictive factors allows for the optimization of patient management, particularly for high-risk individuals, and enhances their follow-up care. The objective of our study is to analyze the prevalence and predictive factors of recurrent hemorrhage after esophageal variceal ligation. This is a prospective analytical study conducted over one year (May 2023 – May 2024), including patients with portal hypertension who underwent endoscopic ligation sessions. Our results showed that the average patient age was 55 years, with a male predominance. The main etiologies of portal hypertension were dominated by cirrhosis (80%), primarily post-viral (23%). Portal vein thrombosis was present in 15% of patients, while Budd-Chiari syndrome was identified in 5%. Ligation was performed as secondary prophylaxis in 92% of cases. Grade III esophageal varices were the most common initial endoscopic finding (85% of cases). Eradication was achieved in 46% of cases after an average of 2.6 sessions. The recurrence rate of hemorrhage was 18%, with a mean recurrence period of three weeks. Among these patients, 41% had Child-Pugh class B cirrhosis, and 58% were not receiving beta-blockers. Hemorrhage-related mortality was observed in three patients. A significant correlation was found between the risk of recurrence and factors such as age, beta-blocker use, and Child-Pugh and MELD scores.