FREQUENCY OF REBLEEDING IN THE FIRST 6 MONTHS AFTER BAND LIGATION IN DECOMPENSATED CHRONIC LIVER DISEASE PATIENTS

Background: Variceal bleeding is one of the most serious complications of decompensated chronic liver disease (DCLD) and is associated with high morbidity and mortality. Endoscopic variceal ligation (EVL) remains the preferred therapeutic option, yet early rebleeding continues to pose significant clinical challenges, particularly in patients with advanced hepatic dysfunction. Identifying predictive factors for recurrent haemorrhage is critical for risk stratification, tailoring surveillance strategies, and improving patient outcomes in high-burden, resource-limited settings. Objective: To determine the clinical, demographic, and disease-related predictors associated with rebleeding within six months after EVL in patients with DCLD managed at Jinnah Postgraduate Medical Centre, Karachi. Methods: This cross-sectional study was conducted between June 2023 and May 2024 and included 144 patients aged 40–70 years with a confirmed diagnosis of DCLD who underwent EVL. Patients with hepatocellular carcinoma, peptic ulcer disease, or significant systemic comorbidities were excluded. Demographic details, comorbid conditions such as diabetes mellitus, hypertension, and dyslipidemia, as well as liver disease severity using the Child–Pugh classification, were recorded. Patients were monitored through outpatient visits and telephone follow-ups for six months. Rebleeding was defined as clinically significant haemorrhage confirmed endoscopically between 24 hours and six months post-procedure. Data were analysed using SPSS version 20, with categorical variables assessed using chi-square tests and a significance level set at p ≤ 0.05. Results: Rebleeding occurred in 28 out of 144 patients, yielding an incidence of 19.4%. Significant predictors of rebleeding included advanced liver disease (Child–Pugh Class C, p < 0.001), diabetes mellitus (18 out of 56 cases, p = 0.004), and hypertension (14 out of 48 cases, p = 0.028). Patients with Class C disease exhibited markedly higher recurrence, while smoking showed a non-significant association (p = 0.093). Conclusion: Rebleeding following EVL remains a frequent complication in patients with advanced hepatic dysfunction and coexisting comorbidities. Early recognition of these high-risk groups is essential for optimizing management strategies and tailoring surveillance to reduce recurrence and improve clinical outcomes.