Management Outcomes of Variceal Bleeding in Northern Tanzania: Insights From a Single-Center Retrospective Analysis

Aims

Due to the expensiveness and unavailability of endoscopy management in Tanzania, the management outcomes of variceal bleeding are unknown. The objective of this study was to assess the management outcomes of patients with variceal bleeding.

Methods

This was a retrospective study conducted between April 2012 and April 2022. The study enrolled all patients diagnosed with variceal bleeding aged 18 years and older. Socio-demographic and clinic characteristics, treatment modalities, and outcomes were collected. Statistical analysis was done using a chi-square test. Multivariable logistic regression was used to determine factors associated with rebleeding and mortality. A p-value of ≤ 0.05 was considered statistically significant.

Results

A total of 534 patients were enrolled based on diagnostic endoscopy findings. Esophageal varices were identified in 88.9% of patients, gastric varices in 0.9%, and 10.1% had both. Conservative treatment was given to 77.5% of patients, and endoscopic treatment was performed in 22.5%: endoscopic variceal ligation (17.6%), endoscopic injection sclerotherapy (4.3%), and both (0.6%). Rebleeding occurred in 40.1%, and factors associated with rebleeding were patients without insurance (p = 0.037), without comorbidities (p = 0.042), with non-communicable diseases (p = 0.039), and with chronic infections (p = 0.035). In-hospital mortality was 8.1%, and factors associated with mortality were a shorter length of stay (p = 0.045), patients without comorbidities (p = 0.041), and grade II esophageal varices (p = 0.043).

Conclusion

This study shows a high rate of variceal bleeding among patients treated conservatively. Mortality and rebleeding rates in our setting remain high, which appears to be due to the expensiveness and unavailability of endoscopic treatment. Available endoscopic interventions will be vital in improving the outcomes of patients with variceal bleeding.