Background: Acute variceal hemorrhage (AVH) is a frequent cause of upper gastrointestinal
bleeding (UGIB) in liver cirrhosis. Most cases require urgent endoscopic intervention
due to potentially life-threatening courses. Different endoscopic hemostasis techniques
can be used, in particular endoscopic variceal ligation (EVL) and endoscopic sclerotherapy
(EST), depending on the bleeding side (esophageal, fundal, and gastric) as well as
radiological interventions (e.g., embolization and transjugular intrahepatic portosystemic
shunt [TIPS]). This study aimed to investigate trends in incidence, treatment modalities,
and outcome parameters, such as in-hospital mortality and adverse events in Germany.Methods:
We evaluated the current epidemiological trends, therapeutic strategies, and in-hospital
mortality of AVH in Germany based on the standardized hospital discharge data provided
by the German Federal Statistical Office from 2010 to 2019.Results: A total of 65,357
AVH cases, predominately males (68.3%), were included in the analysis. The annual
incidence rate (hospitalization cases per 100,000 persons) was 8.9. The in-hospital
mortality was 18.6%. The most common underlying disease was alcohol-related liver
cirrhosis (60.6%). The most common clinical complication was bleeding anemia (60.1%),
whereas hypovolemic shock (12.8%) was the less frequent. In esophageal variceal hemorrhage
(EVH), EVL was the most frequently performed endoscopic therapy, while in gastric
variceal hemorrhage (GVH), EST and fibrin glue injection were the most commonly performed
therapies. EVL showed the lowest in-hospital mortality (12.3%) in EVH, while EST showed
favorable results (14% in-hospital mortality) in GVH. Combination therapies overall
showed a higher in-hospital mortality and were more frequent in GVH. The presence
of hypovolemic shock, AKI, sepsis, artificial ventilation, ARDS, bleeding anemia,
hepatic encephalopathy, and male sex was associated with a significantly worse outcome.Conclusion:
Our study provides detailed insight into the incidence, patient-related risk factors,
endoscopic treatment, and in-hospital mortality in a sizeable AVH collective in Germany.
These data might help improve risk stratification and treatment strategies for AVH
patients in the future.
