{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T13:20:59Z","timestamp":1773667259128,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Acute variceal bleeding (AVB) in cirrhotic patients remains associated with considerable early rebleeding and mortality despite guideline-based therapy. Endoscopic band ligation (EBL) is recommended as first-line therapy for esophageal variceal bleeding, while alternative endoscopic hemostasis strategies may be required when EBL is technically difficult or judged unsafe. Materials and Methods: We conducted a single, tertiary referral center retrospective cohort study of adults with cirrhosis and AVB undergoing emergency endoscopy. Hemostasis modality at index endoscopy was EBL or argon plasma coagulation (APC), used selectively at the endoscopist\u2019s discretion when bleeding was sourced to gastric varices or when EBL was technically difficult or unsafe. The primary endpoint was 5-day rebleeding, with key secondary endpoints set as 6-week mortality and in-hospital mortality. ICU admission and time to endoscopy were evaluated as process and outcome metrics. Multivariable models were used, adjusted for liver severity (MELD-Na, ALBI, PALBI) and bleeding and mortality scores (AIMS65, Rockall, Glasgow Blatchford). Results: Among 181 eligible AVB cases (APC n = 29, EBL n = 152), 5-day rebleeding was higher with APC (31%) than EBL (13.8%). In-hospital mortality (APC 20.7% vs. EBL 23.0%) and 6-week mortality (APC 31.0% vs. EBL 35.5%) were similar. In adjusted models (age, MELD-Na, time to endoscopy), APC was associated with increased odds of 5-day rebleeding (aOR 2.73, 95% CI 1.06\u20137.03), but not with in-hospital (aOR 0.51) or 6-week mortality (aOR 0.45). Time to endoscopy was not independently associated with mortality in adjusted models. Discrimination for in-hospital mortality was highest for MELD-Na (AUC 0.898) and ALBI (AUC 0.859). Conclusions: In this observational AVB cohort, APC, used as a rescue or alternative strategy, showed similar short-term mortality compared with EBL after adjustment for liver severity and was associated with higher 5-day rebleeding. APC may be a pragmatic option when EBL is not feasible or is judged unsafe. However, prospective evaluation and careful selection are warranted.<\/jats:p>","DOI":"10.3390\/medicina62030547","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T11:13:14Z","timestamp":1773659594000},"page":"547","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Argon Plasma Coagulation as Rescue Endoscopic Hemostasis for Acute Variceal Bleeding in Cirrhosis: A Retrospective Cohort Comparison with Band Ligation"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3850-9008","authenticated-orcid":false,"given":"Ilie Marius","family":"Ciorba","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Institution Organizing University Doctoral Studies (IOSUD), \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Gastroenterology, Mure\u0219 County Emergency Clinical Hospital, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0863-3473","authenticated-orcid":false,"given":"Nicoleta","family":"Cr\u0103ciun Ciorba","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Internal Medicine, Mure\u0219 County Emergency Clinical Hospital, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona Maria","family":"B\u0103\u021bag\u0103","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Gastroenterology, Mure\u0219 County Emergency Clinical Hospital, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1097\/HEP.0000000000000647","article-title":"AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis","volume":"79","author":"Kaplan","year":"2024","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1055\/a-1939-4887","article-title":"Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Gralnek","year":"2022","journal-title":"Endoscopy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/HEP.0000000000000530","article-title":"AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage","volume":"79","author":"Lee","year":"2024","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"599","DOI":"10.5152\/tjg.2024.23507","article-title":"Non-variceal Upper Gastrointestinal Bleeding and Its Endoscopic Management","volume":"35","author":"Wasserman","year":"2024","journal-title":"Turk. 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