Prophylactic endotracheal intubation before endoscopic surgery reduces the rebleeding rate in acute esophagogastric variceal bleeding patients

Abstract

Objectives: Esophagogastric variceal bleeding (EVB) is one of the main causes of cirrhosis-related deaths, and endoscopic therapy is the first-line treatment of choice. However, the efficacy of prophylactic endotracheal intubation (PEI) before endoscopy remains controversial. Methods: Data were collected from 119 patients who underwent endoscopic confirmation of an EVB. Inverse probability of treatment weighting was applied to reduce bias between the two groups. The primary outcomes included rebleeding rates within 24 h and 6 weeks post-endoscopic surgery and 6-week mortality. Results: After endoscopic surgery, the rebleeding rate within 24 h in the PEI group was significantly lower than non-PEI group (1.2 % VS 12.6 %, P-value = 0.025). Although PEI did not reduce 6-week mortality, it significantly reduced the risk of rebleeding within 24 h (odds ratio [OR]: 0.89, 95 % confidence interval [CI]: 0.82–0.97, P = 0.008) and within 6 weeks (hazard ratio [HR]: 0.36, 95%CI: 0.14–0.90, P = 0.029). In multivariate regression analyses, maximum varices diameter >1.5 cm (OR: 1.23, 95 % CI: 1.09–1.37, P < 0.001) was independent risk factor for rebleeding within 24 h. Creatinine (HR: 1.01, 95 % CI: 1.01–1.02, P < 0.001) and international normalized ratio (HR: 2.99, 95 % CI: 1.99–4.65, P < 0.001) were independent risk factors for rebleeding within 6 weeks. Conclusions: PEI before endoscopic surgery reduced the incidence of rebleeding within 24 h and 6 weeks after endoscopic surgery. However, PEI did not reduce the 6-week mortality rate after endoscopic surgery and might increase the length of hospital stay.

Keywords

• Cirrhosis
• Esophagogastric variceal bleeding
• Prophylactic endotracheal intubation
• Endoscopy
• Complication