B0311 - The Impact of Enteral Tube Placement in Patients Presenting With Esophageal Variceal Bleeding

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

YH

Yassmin Hegazy, MD

University of Alabama at Birmingham
Birmingham, AL

Yassmin Hegazy, MD¹, Parth Patel, MD¹, Meagan Reif, MD¹, Mark Beasley, PhD¹, Mohamed Shoreibah, MD²
¹University of Alabama at Birmingham, Birmingham, AL; ²University of Alabama Birmingham, Birmingham, AL

Introduction: Enteral tube (ET) placement in patients with gastrointestinal bleeding from esophageal varices is commonly approached with caution. Our study examines the frequency and impact of ET placement in patients presenting with esophageal variceal bleeding.

Methods: We performed a retrospective review study examining patients presenting with esophageal variceal bleeding and undergoing esophagogastroduodenoscopy (EGD) at our institution between May 2017 to September 2021. Patient demographics, co-comorbidities, beta-blocker use, and ET placement were recorded. Other data included length of stay (LOS) in days in the hospital and intensive care unit (ICU), days of intubation, as well as packed red blood cell transfusion requirement and mortality. Mean ± standard deviation (SD) was recorded with adjusted mean calculated for beta-blocker use, hypertension (HTN), Diabetes Mellitus (DM), and Hepatocellular Carcinoma (HCC). A Mann-Whitney U-test, Welch t-test, and a heteroscedastic linear model were used to obtain the odds ratio (OR), confidence interval (CI), and calculate statistical significance (p-value< 0.05).

Results: Our cohort consisted of 87 patients: 69% male, 84% white with an average age of 56.0±10.6, Body Mass Index (BMI) 27.4±7.1, Model for End Stage Liver Disease (MELD-Na) 20.5±9.0, and the most common liver cirrhosis etiology being alcohol (39%). Among our cohort, 84% were treated with esophageal variceal banding and 32% had prophylactic beta-blocker use. Compared to patients without ET placement (N=63), patients with ET placement (N=24) had increased transfusion requirements (95.8% vs 73.0%, [OR 6.59, 95% CI 0.70, 62.42, p-value 0.10] and higher mortality (54.2% vs 14.3%), [OR 6.67, 95% CI: 1.50, 29.77, p-value 0.01]. Mean LOS in the hospital and ICU and days of intubation were also higher among patients with ET placement (8.29 vs 24.14 LOS in the hospital, 4.22 vs 17.25 LOS in the ICU, 5.96 vs 1.75 days of intubation) with all statistical significance (Table 1).

Discussion: Our study shows that ET placements in patients with esophageal variceal bleeding is associated with prolonged hospitalization, intubation, and ICU stay with higher transfusion requirements. Our study also indicates that there is a concern for causality from ET placement that can be related to tube trauma or negative pressure caused by intermittent suctioning that can exacerbate bleeding and lead to worse outcomes. Further studies are needed to determine the safety of ET placement in this patient population.

Outcomes:	No ET Placement (N=63)	ET Placement (N=24)	p-value
Death	9 (14.29%)	13 (54.17%)	0.0129
Transfusion	46 (73.02%)	23 (95.83%)	0.1004
Hospital LOS
Mean ± SD	7.75 ± 5.73	24.54 ± 24.59	0.0029^W
Adjusted Mean*	8.29	24.14	0.0054^H
ICU LOS
Mean ± SD	3.86 ± 4.31	17.33 ± 24.19	0.0122^W
Adjusted Mean*	4.22	17.25	0.0177^H
Intubation LOS
Mean ± SD	1.60 ± 2.32	6.04 ± 5.42	0.0006^W
Adjusted Mean*	1.75	5.96	0.0014^H

Table: Table 1: Outcomes of Enteral Tube Placement:
* Adjusted for age, gender, race, MELD, beta-blocker use, and history of HTN, DM, and HCC.
LOS: Length of Stay, SD: Standard deviation, ET: Enteral Tube
H: p-value from heteroscedastic linear models. W: p-value based on Welch t-test.

Disclosures:

Yassmin Hegazy indicated no relevant financial relationships.

Parth Patel indicated no relevant financial relationships.

Meagan Reif indicated no relevant financial relationships.

Mark Beasley indicated no relevant financial relationships.

Mohamed Shoreibah indicated no relevant financial relationships.

Yassmin Hegazy, MD¹, Parth Patel, MD¹, Meagan Reif, MD¹, Mark Beasley, PhD¹, Mohamed Shoreibah, MD². B0311 - The Impact of Enteral Tube Placement in Patients Presenting With Esophageal Variceal Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.