P5190 - Evaluating the Role of Nutritional Timing and Consistency After Variceal Banding: Evidence From a Multicenter-Center Investigation

Ali Jaan, MD¹, Muhammad Farhan Ashraf, MD², Yousef Waly, MB, BCh, BAO³, Farooq Chaudhary, MBBS³, Majd Haj-Rubaeih, MBBS³, Tariq Alamin, MBBS⁴, Waddah Abd El-Radi, MD³, Keerthi Mannumbeth. Renjith, MD³, Marina Takawy, MD³, Adeena Maryyum, ⁵, Asim Mushtaq, MD², Erik Olson, DO⁴, Karin Dunnigan, MD⁴
1Unity Hospital, Rochester, NY; 2Rochester Regional Health, Rochester, NY; 3Rochester Regional Health, Unity Hospital, Rochester, NY; 4Rochester General Hospital, Rochester, NY; 5Ayub Medical College, Abbottabad, North-West Frontier, Pakistan

Introduction: Variceal upper gastrointestinal bleeding (VUGIB) is a life-threatening complication of decompensated cirrhosis. While the therapeutic role of urgent variceal band ligation (VBL) in managing VUGIB is established, the influence of early nutritional advancement post-banding remains unclear. There is variability in practice patterns when it comes to the optimal timing for resuming oral intake, as well as consistency of diet after VBL. This study aims to explore the associations of both the timing and consistency of nutrition introduced following inpatient VBL.

Methods: We conducted a retrospective study including patients admitted with VUGIB who underwent VBL at Rochester General and Unity Hospitals from 2016-2023. Data were collected on demographics, cirrhosis etiology, Child-Pugh classification, number of variceal bands placed, and the timing and consistency of nutrition introduction. Outcomes were assessed using regression analysis.

Results: : A total of 102 patients who underwent inpatient VBL were included, with a mean age of 57.75 years. Of these, 40 (39.22%) were female, 81% were White Americans, and approximately 50% had alcohol-related cirrhosis. Stratification by Child-Pugh class showed that 38.24% had Class A cirrhosis, 44.12% had Class B, and 17.64% had Class C. The mean number of variceal bands applied per patient was 4.27. Patients who received early nutrition (within 12 hours) had lower rates of rebleeding (9.43%), infections (9.43%), and hepatic encephalopathy (5.66%) compared to those with delayed nutrition (after 24 hours), who exhibited higher rates of complications (Table 1). However, these differences were not statistically significant. The length of hospital stay (LOS) was significantly longer in the after 24-hour group (adjusted coefficient 1.03, P=0.03). Analysis of the relationship with diet consistency did not reveal a statistically significant difference in outcomes (Table 2). However, patients who were transitioned to a regular diet in > 2 days had longer LOS (adjusted coefficient 1.20, P< 0.01).

Discussion: In conclusion, our findings suggest that early initiation of diet following VBL is a safe practice, as it is not associated with rebleeding, infections, or hepatic encephalopathy. Furthermore, the groups with delayed diet initiation and delayed transition to regular diet experienced extended hospital stays, thereby reinforcing the advantages of early dietary commencement.



Figure: Table 1. Clinical outcomes stratified by timing of diet initiation after variceal band ligation. Adjusted
odds ratios (OR) and P-values are reported for the 13–24 hour and >24-hour groups, using the 0–12 hour group as the reference.



Figure: Table 2. Clinical outcomes stratified by diet consistency introduced after variceal band ligation. Adjusted
odds ratios (OR) and P-values are reported for full liquid and mechanical soft/regular diets, using clear liquid diet as the reference group.


Disclosures:
Ali Jaan indicated no relevant financial relationships.
Muhammad Farhan Ashraf indicated no relevant financial relationships.
Yousef Waly indicated no relevant financial relationships.
Farooq Chaudhary indicated no relevant financial relationships.
Majd Haj-Rubaeih indicated no relevant financial relationships.
Tariq Alamin indicated no relevant financial relationships.
Waddah Abd El-Radi indicated no relevant financial relationships.
Keerthi Renjith indicated no relevant financial relationships.
Marina Takawy indicated no relevant financial relationships.
Adeena Maryyum indicated no relevant financial relationships.
Asim Mushtaq indicated no relevant financial relationships.
Erik Olson indicated no relevant financial relationships.
Karin Dunnigan indicated no relevant financial relationships.

Ali Jaan, MD¹, Muhammad Farhan Ashraf, MD², Yousef Waly, MB, BCh, BAO³, Farooq Chaudhary, MBBS³, Majd Haj-Rubaeih, MBBS³, Tariq Alamin, MBBS⁴, Waddah Abd El-Radi, MD³, Keerthi Mannumbeth. Renjith, MD³, Marina Takawy, MD³, Adeena Maryyum, ⁵, Asim Mushtaq, MD², Erik Olson, DO⁴, Karin Dunnigan, MD⁴. P5190 - Evaluating the Role of Nutritional Timing and Consistency After Variceal Banding: Evidence From a Multicenter-Center Investigation, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.