S1411 Evaluating the Role of Nutritional Timing and Consistency After Variceal Banding: Evidence From a Multicenter-Center Investigation

Introduction: Variceal upper gastrointestinal bleeding (VUGIB) is a life-threatening complication of decompensated cirrhosis. While the therapeutic role of urgent variceal band ligation (VBL) in managing VUGIB is established, the influence of early nutritional advancement post-banding remains unclear. There is variability in practice patterns when it comes to the optimal timing for resuming oral intake, as well as consistency of diet after VBL. This study aims to explore the associations of both the timing and consistency of nutrition introduced following inpatient VBL. Methods: We conducted a retrospective study including patients admitted with VUGIB who underwent VBL at Rochester General and Unity Hospitals from 2016-2023. Data were collected on demographics, cirrhosis etiology, Child-Pugh classification, number of variceal bands placed, and the timing and consistency of nutrition introduction. Outcomes were assessed using regression analysis. Results: A total of 102 patients who underwent inpatient VBL were included, with a mean age of 57.75 years. Of these, 40 (39.22%) were woman, 81% were White Americans, and approximately 50% had alcohol-related cirrhosis. Stratification by Child-Pugh class showed that 38.24% had Class A cirrhosis, 44.12% had Class B, and 17.64% had Class C. The mean number of variceal bands applied per patient was 4.27. Patients who received early nutrition (within 12 hours) had lower rates of rebleeding (9.43%), infections (9.43%), and hepatic encephalopathy (5.66%) compared to those with delayed nutrition (after 24 hours), who exhibited higher rates of complications. However, these differences were not statistically significant. The length of hospital stay (LOS) was significantly longer in the after 24-hour group (adjusted coefficient 1.03, P = 0.03). Analysis of the relationship with diet consistency did not reveal a statistically significant difference in outcomes. However, patients who were transitioned to a regular diet in >2 days had longer LOS (adjusted coefficient 1.20, P < 0.01). Conclusion: In conclusion, our findings suggest that early initiation of diet following VBL is a safe practice, as it is not associated with rebleeding, infections, or hepatic encephalopathy. Furthermore, the groups with delayed diet initiation and delayed transition to regular diet experienced extended hospital stays, thereby reinforcing the advantages of early dietary commencement.