{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T21:02:54Z","timestamp":1760043774123,"version":"3.37.3"},"reference-count":17,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,9,13]],"date-time":"2017-09-13T00:00:00Z","timestamp":1505260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Balloon tamponade (<jats:styled-content style=\"fixed-case\">BT<\/jats:styled-content>) can bridge patients to salvage therapy for uncontrollable acute variceal haemorrhage (<jats:styled-content style=\"fixed-case\">AVH<\/jats:styled-content>). However, data are limited regarding the reasons for, rate of and outcomes associated with Balloon tamponade use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>First, we performed an single\u2010centre cohort study of all patients (N\u00a0=\u00a0139) with oesophageal acute variceal haemorrhage from 01\/2009 to 10\/2015. Associations between Balloon tamponade use and adherence to four quality metrics (endoscopy within 12\u00a0hours, band\u2010ligation, pre\u2010endoscopy antibiotics and octreotide) were evaluated. Second, we analysed the National Inpatient Sample (2005\u20102011) to determine the association between in\u2010hospital mortality for patients and their hospital's Balloon tamponade\u2014utilization to acute variceal haemorrhage volume ratio.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the national cohort, 5.5% of 140\u00a0521 acute variceal haemorrhage admissions required Balloon tamponade utilization. Adjusting for patient\u2010 and hospital\u2010level confounders, the rate of Balloon tamponade use per acute variceal haemorrhage managed at any given hospital was associated with increased mortality for all\u2010comers with acute variceal haemorrhage. Compared to the lowest tertile, acute variceal haemorrhage admissions in the highest Balloon tamponade utilizers were associated with increased mortality of (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>1.17 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> (1.01\u20101.37).<\/jats:p><jats:p>In the single\u2010centre cohort, 14 (10.1%) patients required Balloon tamponade. Balloon tamponade utilization was significantly associated with alcohol abuse (50.4% vs 21.4%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.04), hepatocellular carcinoma (35.7% vs 8.8%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), higher median model for end\u2010stage liver disease (<jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content>) score (26.3vs15.5, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.002) and active bleeding during endoscopy (64.3% vs 27.5%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01). Failure to provide all quality metrics was associated with a higher model for end\u2010stage liver disease\u2010adjusted risk of Balloon tamponade use: <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 16.7 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>(4.17\u2010100.0, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Balloon tamponade use is associated with severity of bleeding but may also implicate deficits in processes of care. Even for patients who did not need Balloon tamponade, presentation to hospitals with high Balloon tamponade utilization increases their odds of dying from acute variceal haemorrhage.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13559","type":"journal-article","created":{"date-parts":[[2017,8,24]],"date-time":"2017-08-24T14:44:23Z","timestamp":1503585863000},"page":"477-483","source":"Crossref","is-referenced-by-count":5,"title":["Hospital\u2010level balloon tamponade use is associated with increased mortality for all patients presenting with acute variceal haemorrhage"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0839-1515","authenticated-orcid":false,"given":"Elliot B.","family":"Tapper","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Michigan  Ann\u00a0Arbor MI USA"},{"name":"Institute for Healthcare Policy and Innovation  Ann Arbor MI USA"},{"name":"Veterans Affairs Hospital  Ann Arbor MI 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Hepatology Beth Israel Deaconess Medical Center Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Curry","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer D.","family":"Saini","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Michigan  Ann\u00a0Arbor MI USA"},{"name":"Institute for Healthcare Policy and Innovation  Ann Arbor MI USA"},{"name":"Veterans Affairs Hospital  Ann Arbor MI USA"},{"name":"Veterans Affairs Center for Clinical Management Research (CCMR)  Ann Arbor MI 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