IDDF2022-ABS-0145 Comparative effectiveness of different techniques of endoscopic hemostasis in active variceal bleeding

BackgroundEffective control of hemostasis in variceal bleeding remains a pressing problem. Various technical solutions to achieve stable hemostasis and appropriate tactics are regularly discussed. Our aim was to compare different techniques for endoscopic stopping of ongoing (active) variceal bleeding.MethodsAll patients with active variceal bleeding who were admitted in 2015–2022 were included. Gastroscopy was performed immediately on admission. To stop bleeding, intravenous administration of microfoam of polidocanol solution (52 patients), perivascularally submucosal infiltration of 1% hydrogen peroxide solution 10–20 ml (50 patients) and ligation by elastic rings (3 patients) were used.ResultsPrimary endoscopic hemostasis was effective in 103 of 105 patients (98%). In two patients with profuse bleeding in the terminal state, the use of endoscopic hemostasis was found unnecessary in favor of the Blackmore probe. The total endoscopy time was 6±2.4 minutes with sclerosant microfoam, 10±3.2 minutes with infiltration hemostasis (p=0,0000), and 18±4.1 minutes with ligation (p=0,0001).The time to achieve hemostasis (instrumental aid proper) was 2±1 minutes with sclerosant microfoam, 3±1.8 minutes with infiltration hemostasis (p=0,0010), and 15 minutes with ligation (p=0,0000).The frequency of recurrent bleeding was 6 patients (12%) with sclerosant microfoam, 8 patients (16%) with infiltration hemostasis, and 0 patients with ligation (Chi-square=0,03, p=0,8658).The greatest problems arose with the use of elastic rings because of the constant loss of field of vision. The use of a water pump proved to be mandatory for ligation.ConclusionsInjection methods of hemostasis require less time at the height of variceal bleeding. Hemostasis with sclerosant microfoam is the most attractive in terms of technique, cost, achievement of phlebitis and recurrence of hemorrhages. The use of elastic rings at the height of variceal bleeding is technically significantly more difficult and expensive.