ABSTRACT Aims Esophagogastric variceal bleeding (EGVB) is a life‐threatening complication associated with cirrhosis and portal hypertension. Although endoscopic treatment is central to EGVB management, evidence of its effectiveness in acute‐on‐chronic liver failure (ACLF) remains limited because of severe coagulation and multi‐organ dysfunction. This study aims to evaluate the efficacy of endoscopic treatment in ACLF patients with EGVB and identify prognostic factors associated with 6‐week rebleeding and mortality. Methods In this single‐center retrospective cohort study, we analyzed 106 patients with ACLF experiencing an EGVB episode between January 1, 2021, and June 30, 2024. Patients were categorized into endoscopic and non‐endoscopic treatment groups. Endoscopic treatment was performed within 12 to 24 h after admission once hemodynamic stability was achieved. The primary outcomes were 6‐week rebleeding rate and 6‐week all‐cause mortality, and the secondary outcome was bleeding‐related mortality. Multivariable logistic regression was used to identify risk factors for early rebleeding (72 h to 6 weeks), 6‐week mortality, and hemorrhage‐related death. Results Early rebleeding occurred in 36.8% (39/106) of patients. Moderate‐to‐severe ascites independently predicted early rebleeding (odds ratio OR = 3.379, 95% confidence interval CI, 1.376–8.300, p = 0.008). By contrast, endoscopic treatment was a protective factor (OR = 0.266, 95% CI, 0.108–0.657, p = 0.004). The early rebleeding rate was significantly lower in the endoscopic group (26.8%, 19/71) compared to the non‐endoscopic group (57.1%, 20/35; p = 0.002). The 6‐week mortality was 46.2% (49/106) and was associated with moderate‐to‐severe ascites (OR = 2.587, 95% CI, 1.043–6.418, p = 0.040) and elevated total bilirubin level (OR = 1.004, 95% CI, 1.001–1.008, p = 0.012). First bleeding was a protective factor (OR = 0.304, 95% CI, 0.120–0.772, p = 0.012). Endoscopic treatment did not significantly affect overall survival ( p = 0.734) but reduced hemorrhage‐related mortality (OR = 0.186, 95% CI, 0.040–0.857, p = 0.031). Among the 49 deaths, 20 were attributed to gastrointestinal hemorrhage and 29 to other causes, primarily severe infections ( n = 12), hepatic encephalopathy ( n = 7), and renal failure ( n = 7). Portal vein thrombosis (PVT) was independently associated with bleeding‐related death regardless of whether endoscopic treatment was performed (OR = 8.262, 95% CI, 1.514–45.092, p = 0.015). Conclusion In ACLF patients with EGVB, moderate‐to‐severe ascites was the key predictor of early rebleeding and 6‐week mortality. Endoscopic therapy reduced early rebleeding and hemorrhage‐related death but did not improve overall survival; higher total bilirubin levels, prior bleeding, and PVT may further identify high‐risk patients.
Sun et al. (Mon,) studied this question.