Esophageal variceal rupture is a major complication of portal hypertension in cirrhotic patients, leading to a high risk of upper gastrointestinal bleeding. Although endoscopic variceal ligation (EVL) is a cornerstone of both primary and secondary prophylaxis, rebleeding remains frequent. This study aims to determine the average time required for variceal eradication and to identify predictors of hemorrhagic recurrence to improve the management of cirrhotic patients treated with EVL.

This was a retrospective, descriptive, and analytical study conducted over a five-year period, from January 1st, 2019 to 31 October, 2025, within our department. The study included all patients followed for cirrhosis who underwent an upper GI endoscopy (EGD) with esophageal variceal ligation. Patients were divided into two groups: Group I: 40 cirrhotic patients in whom variceal eradication was achieved within ≤ 3 months and Group II: 28 cirrhotic patients in whom eradication was achieved after > 3 months. Data were collected from patient medical records and endoscopy reports. Descriptive data analysis was performed using a standardized data collection form, while statistical analysis was carried out using JAMOVI software.

During the study period, 172 patients underwent EGD with EVL. Among them, 68 (39.5%) were cirrhotic. Cirrhosis was of indeterminate etiology in 21 patients (30.9%). Post-viral hepatitis B cirrhosis was found in 9 patients (13.2%) and post-viral hepatitis C cirrhosis in 8 patients (11.8%).

Group I

The male-to-female ratio was 1.2 (22 men, 18 women). The mean age was 50.4 years (range 19–74).EVL was performed as primary prophylaxis in 23 patients (57.5%) and as secondary prophylaxis in 17 patients (42.5%). Beta-blockers were used for primary prophylaxis in 21 patients (52.5%) and for secondary prophylaxis in 19 patients (47.5%). According to the Child-Pugh classification, 17 (42.5%) were Child A, 14 (35%) Child B, and 9 (22.5%) Child C. Endoscopically, 26 patients (65%) had grade III varices and 14 (35%) had grade II varices. Most patients presented red signs (72.5%; n=29) and more than three variceal columns (80%; n=32).The mean number of bands applied per session was 4 (1–7). The mean number of sessions required for variceal eradication was 6 (2–7). The mean interval between the first and last ligation sessions was 56 days (14–84).Hemorrhagic recurrence occurred in 5 patients (12.5%). Eradication within ≤ 3 months was associated with EVL performed as primary prophylaxis (p=0.003) and with the use of beta-blockers in primary prophylaxis (p=0.0004).

Group II

The male-to-female ratio was 1.5 (17 men, 11 women). The mean age was 50.7 years (range 25–74).EVL was performed as primary prophylaxis in 6 patients (21.4%) and as secondary prophylaxis in 22 patients (55%). Beta-blockers were used for primary prophylaxis in 5 patients (17.9%) and for secondary prophylaxis in 23 patients (82.1%). According to the Child-Pugh score, 10 (35.5%) patients were Child A, 11 (39.3%) Child B, and 7 (25%) Child C. Endoscopically, 22 patients (55%) had grade III varices and 6 (21.4%) grade II varices. Red signs were present in 75% (n=21), and more than three variceal columns in 96.4% (n=27).The mean number of bands applied per session was 5 (2–7). The mean number of sessions required for eradication was 8 (3–9). The mean time between the first and last sessions was 154 days (112–336). Hemorrhagic recurrence occurred in 9 patients (32.1%). Eradication beyond 3 months was associated with secondary prophylaxis (p=0.003), the use of beta-blockers in secondary prophylaxis (p=0.0004), and hemorrhagic recurrence (p=0.049).

Endoscopic variceal ligation (EVL) is a key treatment for cirrhotic patients at risk of variceal bleeding. Our study shows that anticoagulant use is a significant predictor of hemorrhagic recurrence and that early EVL combined with beta-blockers may improve effectiveness and shorten variceal eradication time.