Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding

BACKGROUND AND AIMS: The role of propranolol in addition to EVL in the prevention of first variceal bleed has not been evaluated. This prospective randomized controlled trial compared endoscopic variceal ligation (EVL) with propranolol and EVL alone in the prevention of first variceal bleed among patients with high-risk varices. PATIENTS AND METHODS: One hundred and forty-four consecutive patients with high-risk varices were randomly allocated to EVL plus propranolol (Gr I, n = 72) or EVL alone (Gr II, n = 72). EVL was done at 2-wk interval till obliteration of varices. In Gr I, incremental dosage of propranolol (sufficient to reduce heart rate to 55 beats/min or 25% reduction from baseline) was administered and continued after obliteration of varices. The endpoints of the study were bleeding and death. RESULTS: The two groups of patients had comparable baseline characteristics; follow-up (Gr I: 13.1 +/- 11.5 months, Gr II: 11.2 +/- 9.9 months), number of cirrhotic and noncirrhotic portal hypertension patients [Gr I 64 (88.6%) and 8 (11.4%), Gr II 63 (87.5%) and 9 (12.5%)], and frequency of Child's A (15 vs 18), B (38 vs 35), and C (19 vs 19). The mean daily propranolol dose achieved in Gr I was 95.6 +/- 38.6 mg. Eleven patients had bleeds, 5 in Gr I and 6 in Gr II. All patients bled before the obliteration of varices, the actuarial probability of first bleed at 20 months was 7% in Gr I and 11% in Gr II (p= 0.72). Six patients died in the combination and 8 in EVL group. All deaths in Gr I were due to nonbleed-related causes, while in Gr II, 2 deaths were bleed related, the actuarial probability of death at 20 months was 8% and 15%, respectively (p= 0.37). The probability of bleed-related death was comparable (p= 0.15). At the end of follow-up, 4 patients in Gr I and 11 in Gr II had recurrence of varices (p= 0.03). Side effects on propranolol were seen in 22% patients, in 8% it had to be stopped. There were no serious complications of EVL. CONCLUSIONS: Both EVL plus propranolol and EVL alone are effective in primary prophylaxis of bleed from high-risk varices. Addition of propranolol does not decrease the probability of first bleed or death in patients on EVL. However, the recurrence of varices is lower if propranolol is added to EVL.     

Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis

BACKGROUND AND AIM: To compare the efficacy and safety of endoscopic variceal ligation (EVL) with propranolol in prophylaxis on the rate of first esophageal variceal bleeding in patients with cirrhosis. METHODS: A prospective, randomized trial was conducted in 100 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death. RESULTS: Life-table curves showed that prophylactic EVL and propranolol were similarly effective for primary prophylaxis of variceal bleeding (11/50 [22%]vs 12/50 [24%]; P = 0.68) and overall mortality (14/50 [28%]vs 12/50 [24%]; P = 0.49). The 2-year cumulative bleeding rate was 18% (9/50) in the EVL group and 16% (8/50) in the propranolol group. The 2-year cumulative mortality rate was 28% (14/50) in the EVL group and 24% (12/50) in the propranolol group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed no significant difference in mortality in both groups (P = 0.86). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. In the propranolol group, the mean daily dosage of the drug was 68.2 +/- 32.8 mg, which was sufficient to reduce the pulse rate by 25%. 20% of patients withdrew from propranolol treatment due to adverse events. CONCLUSIONS: Prophylaxis EVL is as effective and as safe as treatment with propranolol in decreasing the incidence of first variceal bleeding and death in cirrhotic patients with high-risk esophageal varices.     

Primary prophylaxis of variceal bleeding in cirrhotics awaiting liver transplantation

BACKGROUND/AIMS: To evaluate the efficacy and safety of prophylactic band ligation and propranolol versus propranolol alone for the primary prophylaxis of variceal bleeding in patients with high-risk esophageal varices listed for liver transplantation. METHODOLOGY: Out of 152 cirrhotic patients included on the waiting list between January 2001 and January 2003, high-risk esophageal varices were detected in 72. These patients were randomized to undergo combined therapy or propranolol monotherapy. The actuarial probabilities of bleeding from esophageal varices and bleeding-related death were calculated by Kaplan-Meier method and compared using the log-rank test. RESULTS: Variceal eradication was achieved in 33 patients (91.6%) in 2.5 +/- 1.4 ligation sessions. The mean daily dose of propranolol was 72 +/- 25mg in the propranolol group and 68 +/- 21 mg in the ligation group. Six percent of patients in the ligation group and 31% in the propranolol group had one episode of bleeding during the 18 months of follow-up (p = 0.03). The actuarial probabilities of bleeding-free survival after 18 months of follow-up, in the ligation and monotherapy groups were 96% and, respectively, 69% (p = 0.04). CONCLUSIONS: Endoscopic band ligation associated with propranolol significantly reduces the occurrence of the first episode of variceal bleeding and improves bleeding-related survival in cirrhotics included on the waiting list.     

Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage:A meta-analysis

AIM:To compare the effect of endoscopic variceal ligation(EVL)with that of endoscopic injection sclerotherapy(EIS)in the treatment of patients withesophageal variceal bleeding.METHODS:We performed a systematic literature search of multiple online electronic databases.Metaanalysis was conducted to evaluate risk ratio(RR)and95%confidence interval(CI)of combined studies for the treatment of patients with esophageal variceal bleeding between EVL and EIS.RESULTS:Fourteen studies comprising 1236 patients were included in the meta-analysis.The rebleeding rate in actively bleeding varices patients in the EVL group was significantly lower than that in the EIS group(RR=0.68,95%CI:0.57-0.81).The variceal eradication rate in actively bleeding varices patients in the EVL group was significantly higher than that in the EIS group(RR=1.06,95%CI:1.01-1.12).There was no significant difference about mortality rate between the EVL group and EIS group(RR=0.95,95%CI:0.77-1.17).The rate of complications in actively bleeding varices patients in the EVL group was significantly lower than that in the EIS group(RR=0.28,95%CI:0.13-0.58).CONCLUSION:Our meta-analysis has found that EVL is better than EIS in terms of the lower rates of rebleeding,complications,and the higher rate of variceal eradication.Therefore,EVL is the first choice for esophageal variceal bleeding.     

Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial

beta-Blockers and endoscopic variceal ligation (EVL) have proven to be valuable methods in the prevention of variceal rebleeding. The aim of this study was to compare the efficacy of EVL combined with nadolol versus EVL alone as secondary prophylaxis for variceal bleeding. Patients admitted for acute variceal bleeding were treated during emergency endoscopy with EVL or sclerotherapy and received somatostatin for 5 days. At that point, patients were randomized to receive EVL plus nadolol or EVL alone. EVL sessions were repeated every 10 to 12 days until the varices were eradicated. Eighty patients with cirrhosis (alcoholic origin in 66%) were included (Child-Turcotte-Pugh A, 15%; B, 56%; C, 29%). The median follow-up period was 16 months (range, 1-24 months). The variceal bleeding recurrence rate was 14% in the EVL plus nadolol group and 38% in the EVL group (P = .006). Mortality was similar in both groups: five patients (11.6%) died in the combined therapy group and four patients (10.8%) died in the EVL group. There were no significant differences in the number of EVL sessions to eradicate varices: 3.2 +/- 1.3 in the combined therapy group versus 3.5 +/- 1.3 in the EVL alone group. The actuarial probability of variceal recurrence at 1 year was lower in the EVL plus nadolol group (54%) than in the EVL group (77%; P = .06). Adverse effects resulting from nadolol were observed in 11% of the patients. In conclusion, nadolol plus EVL reduces the incidence of variceal rebleeding compared with EVL alone. A combined treatment could lower the probability of variceal recurrence after eradication.     

Endoscopic band ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotic patients with high risk esophageal varices

Background. Gastroesophageal variceal bleeding is a common complication of portal hypertension. Current guidelines recommend β-blockers for primary prophylaxis. However, evidence suggests that endoscopic variceal ligation (EVL) reduce bleeding episodes.Aims. To compare endoscopic EVL with propranolol (PPL) for primary prophylaxis of variceal bleeding.Methods. We conducted a randomized controlled trial. Over a 9-year period, 75 patients with cirrhosis and high-risk esophageal varices (HREV) were recruited and allocated to EVL (n=39) or PPL (n=36). Primary outcome was variceal bleeding. Secondary outcomes were survival, source of bleeding and serious adverse events. Analyses were made by intention-to-treat.Results. Baseline characteristics were similar. Medium follow-up was 1647±1096 days. Complete follow-up was achieved in 85% of patients. Variceal bleeding occurred in 12% of EVL and in 25% of PPL group (p=0.17). The actuarial risks of bleeding after 2 years were similar in both groups. Overall mortality was 51% in EVL and 33% in PPL group (p=0.17). Patients in the EVL group showed a lower rate of esophageal variceal bleeding (5.1% v/s 25%, p=0.027) and a higher rate of subcardial variceal bleeding compared with PPL group (7.7% v/s 0%, p=0.027). Serious adverse events related to EVL occurred in 2 patients, including 1 death.Conclusions. The present study supports that PPL should be considered the first choice in primary prophylaxis of variceal bleeding offering similar effects and lower severe adverse events compared with EVL.     

心得安联合内镜套扎术预防食管静脉曲张再出血的疗效分析

目的比较心得安联合内镜套扎治疗与单独内镜套扎治疗预防食管静脉曲张再出血的疗效。方法 65例食管静脉曲张破裂出血的患者随机分为心得安联合内镜套扎治疗组(33例),单独内镜套扎治疗组(32例),平均随访12个月,比较两组间再出血率,门脉高压性胃病,食管静脉曲张复发和胃底静脉曲张的发生率。结果两组治疗后随访第6,12个月显示,与单独内镜套扎治疗比较,心得安联合内镜套扎治疗显著降低再出血率(15.2%vs 37.5%,21.2%vs 46.9%,P<0.05),门脉高压性胃病(18.2%vs43.8%,30.3%vs 56.3%,P<0.05),食管静脉曲张复发(15.2%vs 37.5%,24.2%vs 50.0%,P<0.05)和胃底静脉曲张的发生率(12.1%vs 34.4%,21.2%vs 46.9%,P<0.05)。结论心得安联合内镜套扎治疗是二级预防食管静脉曲张出血的首选治疗方法。     

心得安单纯或联合使用在二级预防食管静脉曲张出血中的疗效比较

目的比较单纯心得安、套扎＋心得安、硬化剂＋心得安二级预防食管静脉曲张出血的疗效,探寻心得安二级预防食管静脉曲张出血的最佳组合。方法78例食管静脉曲张出血患者随机分成3组,每组26例,止血后分别给予心得安（心得安组）、套扎＋心得安（套扎组）、硬化剂＋心得安（硬化剂组）,比较各组12个月内再出血率、死亡率,以及各组门脉高压性胃病、胃底静脉曲张发生率、食管曲张静脉复发率。结果12个月内再出血率套扎组为30．77％,明显低于心得安组（53．85％）及硬化组（42．31％）（P均〈0．05）;套扎组和心得安组门脉高压性胃病及胃底静脉曲张发生率相似,都明显低于硬化组（P均〈0．05）;而食管静脉曲张再发率高于硬化组（P〈0．05）。结论在应用心得安的基础上进行套扎治疗可能是目前食管静脉曲张出血最有效的二级预防方法。     

Endoscopic variceal ligation vs. propranolol for prevention of first variceal bleeding: a randomized controlled trial

OBJECTIVES: Data in the literature regarding the role of endoscopic variceal ligation for the prevention of first variceal bleeding in cirrhotic patients are controversial. To further explore this issue we have compared ligation and propranolol treatment in a prospective randomized study. METHODS: Sixty patients with cirrhosis and oesophageal varices with no history but at high risk of bleeding were randomized to ligation treatment (30 patients) or propranolol (30 patients). Patients were followed for approximately 27.5 months. RESULTS: Variceal obliteration was achieved in 28 patients (93.3%) after 3+/-1 sessions. The mean daily dose of propranolol was 60.3+/-13.3 mg. Two patients (6.7%) in the ligation group and nine patients (30%) in the propranolol group developed variceal bleeding (P = 0.043). The actuarial risks of variceal bleeding at 2 years were 6.7% and 25%, respectively. On multivariate analysis, propranolol treatment and grade III varices turned out to be predictive factors for the risk of variceal bleeding. Mortality was not different between the two groups. There were no serious complications due to ligation. Propranolol treatment was discontinued in four patients because of side effects. CONCLUSIONS: Variceal ligation is a safe and more effective method than propranolol treatment for the prevention of first variceal bleeding in cirrhotic patients with high-risk varices.     

内镜套扎与普萘洛尔预防肝硬化食管静脉曲张首次出血效能的Meta分析

目的比较内镜下套扎术（EVL）和普萘洛尔预防肝硬化食管静脉曲张首次出血的疗效和安全性。方法计算机检索1999至2012年12月31日PubMed、EBMBASE、万方数据库中关于EVL和普萘洛尔预防肝硬化食管静脉曲张首次出血的随机对照试验,同时追索纳入文献的参考文献。使用RevMan 5.1专业Meta分析软件对治疗后首次出血率,出血病死率,总病死率和不良反应发生率进行Meta分析。结果纳入6个随机对照试验,包括EVL组280例和普萘洛尔组301例患者。文献的Cochrane质量评价均为B级,属于较高质量文献。Meta分析结果显示,EVL在预防肝硬化食管静脉曲张患者的首次出血率、出血病死率、总病死率和不良反应发生率分别为16.4%、4.3%、22.5%和25.0%,与普萘洛尔组的21.6%（P=0.07）、6.3%（P=0.27）、20.9%（P=0.56）和31.9%（P=0.33）相比均无显著性差异;漏斗图存在不对称的现象,提示可能存在发表性偏倚;敏感性分析表明纳入研究具有稳定性。结论EVL与普萘洛尔在预防肝硬化食管静脉曲张破裂的效能无显著性差异。     

内镜静脉曲张结扎术与十四肽生长抑素治疗肝硬化食管静脉曲张破裂出血的疗效比较

目的 比较内镜静脉曲张结扎术与十四肽生长抑素在治疗肝硬化食管静脉曲张破裂出血中的效果.方法 将2003年1月至2006年4月广东省江门市中心医院消化科收治的80例肝硬化食管静脉曲张破裂出血患者分为内镜治疗组(40例)和十四肽生长抑素治疗组(40例).内镜治疗组在内镜下用多环连发皮圈结扎器行静脉曲张结扎术(EVL),然后静脉滴注垂体后叶素7 d;生长抑素治疗组先以十四肽生长抑素持续静脉滴注72 h,再以垂体后叶素静脉滴注持续4 d.结果 内镜治疗组中39例72 h内止血(97.5%).1个月内再出血4例(10%,其中1周内再出血3例),发生肝肾综合征1例,肝性脑病1例,死亡2例(5%).生长抑素治疗组72 h完全止血32例,1个月内再出血5例(12.5%),出现肝肾综合征5例(12.5%),P＞0.05;肝性脑病6例(15%),P＜0.05;死亡6例(15%),P＞0.05.结论 食管静脉曲张皮圈结扎治疗肝硬化食管静脉曲张破裂大出血优于生长抑素治疗,尽早EVL治疗能减少肝性脑病的发生.     

Factors predicting success of endoscopic variceal ligation for secondary prophylaxis of esophageal variceal bleeding

Introduction: Endoscopic obliteration of esophageal varices by endoscopic variceal ligation (EVL) is an effective form of secondary prophylaxis. However, there is no consensus regarding the technical aspects of EVL for secondary prophylaxis. The present study compares the technical aspects of EVL (frequency of sessions, number of sessions and number of bands used) in patients who rebled following secondary prophylaxis of esophageal varices by EVL compared to those who did not rebleed. Methods: All patients who underwent EVL for treatment of acute variceal bleeding followed by EVL for secondary prophylaxis and who subsequently developed recurrent variceal bleeding at Mayo Clinic, Rochester between January 1995 and May 2003 were identified. A control group of patients undergoing EVL for secondary prophylaxis who did not rebleed was identified. Results: During the study period, 216 patients with acute esophageal variceal hemorrhage underwent emergent EVL treatment with follow‐up EVL for secondary prophylaxis, of whom 20 (9.3%) subsequently rebled. Both rebleeding and non‐rebleeding patient groups were well‐matched with respect to liver function (Child–Pugh class), number and size of variceal trunks, endoscopic stigmata of hemorrhage and beta‐blocker usage. The median interval between EVL sessions in the rebleeding group (2 weeks, interquartile range 0–2 weeks) was significantly shorter compared to the non‐rebleeding group (5 weeks, interquartile range 3–7 weeks; P = 0.004). Adjusting for age, gender, and Child–Pugh class, interbanding interval ≥ 3 weeks was associated with increased likelihood of not rebleeding, hazard ratio 3.84 (95% confidence interval: 1.69–11.79; P = 0.0007). Conclusions: These findings demonstrate the importance of technical aspects of EVL on patient outcome, suggesting the benefit of longer interbanding intervals. Future prospective studies are required to define the optimal intersession interval. Standardizing procedural aspects of EVL will aid in objectively evaluating the benefit of this procedure when compared to other modalities such as medical treatment.     

Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis

In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty-two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n = 75) or PPL (n = 77). The groups were well matched with respect to baseline characteristics (age 56 +/- 10 years, alcoholic etiology 51%, Child-Pugh score 7.2 +/- 1.8). The mean follow-up was 34 +/- 19 months. Data were analyzed on an intention-to-treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion, VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long-term PPL treatment.     

内镜下套扎术预防肝硬化食管静脉曲张破裂出血的远期随访观察

目的 观察肝硬化食管静脉曲张患者分别行食管静脉曲张套扎术(endoscopic variceal ligation,EVL)和口服普萘洛尔后的再出血发生率、死亡率、治疗前后静脉曲张程度以及肝功能分级变化.方法 共纳入患者118例,其中66例采用EVL治疗,52例采用药物预防治疗.EVL 治疗组给予多次套扎,直到曲张静脉消失;药物治疗组给予普萘洛尔,起始剂量10 mg,每日2次,逐渐增至最大耐受剂量.对所有患者随访20个月,观察比较两组出血发生率和死亡率、治疗前后静脉曲张程度以及肝功能分级变化.结果 EVL治疗组有效随访58例,其问发生出血7例(12.1%),死亡2例(3.4%);药物治疗组有效随访46例,期间发生出血14例(30.4%),死亡6例(13.0%),两组间差异有统计学意义(P<0.05).EVL治疗组总静脉消失率为41.3%(24/58),药物治疗组46例曲张静脉均未消失;比较两组治疗前后肝功能未见明显变化(P>0.05).结论 与服用普萘洛尔相比,EVL能显著降低出血率、死亡率和静脉曲张程度,且对肝功能无明显损害作用.     

经内镜栓塞术联合套扎术治疗食管胃底静脉曲张出血的疗效观察

目的探讨胃底静脉曲张栓塞术联合内镜下食管静脉曲张套扎术（EVL）治疗肝硬化上消化道出血的疗效。方法经急诊胃镜检查发现活动性胃底静脉曲张出血合并Ⅱ°以上食管静脉曲张且排除其他病因的上消化道出血患者共156例,分为治疗组和对照组,治疗组胃底静脉曲张组织粘合剂栓塞同时食管静脉EVL治疗;对照组胃底静脉曲张组织粘合剂栓塞治疗2个月后行食管静脉EVL。结果两组均未发生与治疗相关的并发症。止血成功率治疗组为96．3％（77／80）,对照组为97．4％（74／76）,（P〉0．05）;近期再出血率治疗组为6．4％（5／78）,对照组为21．3％（16／75）,两组差异有统计学意义（P〈0．05）;两组患者随访6个月,再出血率分别为13．0％（9／69）、25．4％（17／67）,差异有统计学性意义（P〈0．05）。胃底静脉曲张改善总有效率治疗组和对照组分别为61．6％、59．1％,食管曲张静脉改善总有效率为74．0％、67．9％,差异均无统计学意义。结论胃底静脉曲张栓塞联合EVL是治疗肝硬化胃底静脉曲张出血并食管静脉曲张的安全有效方法,同时联合治疗更能降低再出血率。     

Influence of endoscopic variceal ligation on oesophageal motility

BACKGROUND: To determine the change of oesophageal manometry in patients with oesophageal varices before and after oesophageal variceal ligation (EVL). METHODS: Forty-five patients who had liver cirrhosis and oesophageal varices with high risk of bleeding were managed by EVL. Oesophageal manometry was performed just prior to the ligation and 4-6 weeks after obliteration of varices. Another 45 age- and sex-matched patients without hepatic, oesophageal or systemic disease served as the control group. RESULTS: At 5 cm above the lower oesophageal sphincter (LES), the amplitude of the contractive wave was significantly lower in patients before EVL (56.9 +/- 31.8 vs 80.1 +/- 30.1, P< 1.05) and returned to the level of control subjects after EVL (76.5 +/- 37.0 vs 80.1 +/- 30.1, P> 0.05). At 10 cm above LES, the amplitude of the contractive wave was significantly lower in patients before and after EVL than the control group (54.3 +/- 29.2 vs 68.1 +/- 29.5, 54.2 +/- 26.0 vs 68.1 +/- 29.5, respectively, P< 0.05). The percentage of tertiary waves was significantly higher in patients before and after EVL than in the control group (31.4 +/- 36.6 vs 5.8 +/- 15.1, 26.9 +/- 32.9 vs 5.8 +/- 15.1, respectively, P< 0.05). However, no significant swallowing disturbance was noted in patients after EVL. There was significantly greater LES length in patients before EVL (4.0 +/- 0.9 vs 3.4 +/- 0.7, P<0.05) but there was no significant difference in the LES length after EVL as compared with the control group. Eighty-six per cent (39/45) of patients developed paraoesophageal varices and 31% (14/45) developed new varices 6 months after variceal obliteration. However, there was no significant difference in manometry at the time of variceal obliteration between patients with variceal recurrence and those without. CONCLUSIONS: The presence of varices affected oesophageal motility. However, such abnormality had little clinical significance. Endoscopic variceal ligation normalized oesophageal motility and may not induce abnormal oesophageal motility. The manometric change can not be used to predict the recurrence of varices in cirrhotic patients after variceal obliteration.     

经皮经肝组织胶栓塞治疗食管静脉曲张与内镜下套扎治疗的疗效比较

目的比较经皮经肝α氰基丙烯酸正辛酯（TH胶）栓塞术（PTVE）与内镜下食管静脉套扎术（EVL）治疗食管静脉曲张的临床疗效。方法急性及近期食管胃静脉曲张出血的肝硬化患者随机分成PTVE组（52例）及EVL组（50例）进行干预治疗,观察术后上消化道再出血率、食管曲张静脉复发率及生存率。结果随访期间（PTVE组平均24个月,EVL组25个月）两组的上消化道再出血率分别为15．4％（8／52）和42％（21／50）（χ^2=8．87,P=0．005）,其中食管曲张静脉再出血率为5．8％（3／52）和24％（12／50）（χ^2=5．38,P=0．012）,两组食管静脉曲张复发率分别为17．3％（19／52）和52％（26／50）（χ^2=13．61,P〈0．001）,两组生存率相似,（χ^2=3．30,P=0．054）。结论PTVE能使曲张静脉及其穿支静脉和贲门胃底静脉周围静脉一并栓塞,术后食管静脉曲张的再出血率低于EVL治疗,具有较好临床价值。     

Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation

AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without thi...     

Second prophylaxis of variceal bleeding in cirrhotic patients with a high HVPG

Objective: The hepatic venous pressure gradient (HVPG) could be used to stratify patients in different risk groups. No studies have reported the role of transjugular intrahepatic portosystemic shunt (TIPS) placement in a subgroup of patients with a high HVPG (≥20?mmHg) for secondary prophylaxis of variceal bleeding. This study was designed to evaluate the benefit of TIPS in cirrhotic patients with a high HVPG (≥20?mmHg) for rebleeding and survival.

Material and methods: We included 46 cirrhotic patients with a history of variceal bleeding and a high HVPG (≥20?mmHg) admitted to our hospital between January 2013 and June 2014 (TIPS group). Patients were matched by Child-Pugh scores to patients in our historical cohort hospitalized for prophylaxis of variceal rebleeding between April 2011 and December 2012 (propranolol?+?EVL group). The end points included time to significant rebleeding from portal hypertensive sources, 1-year survival, and time to the occurrence of hepatic encephalopathy (HE).

Results: The 1-year actuarial probability of remaining free of variceal rebleeding was significantly higher in the TIPS group than in the propranolol?+?EVL group (85% vs. 54%, p?=?0.01). The 1-year survival rates were not different between the two groups (85% vs. 89%, p?=?0.591). The 1-year actuarial probability of remaining free of HE was significantly lower in the TIPS group than in the propranolol?+?EVL group (67% vs. 91%, p?=?0.003).

Conclusions: TIPS was more effective than propranolol?+?EVL in preventing variceal rebleeding in cirrhotic patients with a high HVPG (≥20?mmHg). During the limited follow-up, survival was similar in the two groups.     

Effect of intravariceal sclerotherapy combined with esophageal mucosal sclerotherapy using small-volume sclerosant for cirrhotic patients with high variceal pressure

AIM: To explore the effect of intravariceal-mucosal sclerotherapy using small dose of sclerosant on the recurrence of esophageal varices.METHODS: We randomly assigned 38 cirrhotic patients with previous variceal bleeding and high variceal pressure (> 15.2 mmHg) to receive endoscopic variceal ligation (EVL) and combined intravariceal and esophageal mucosal sclerotherapy (combined group) using small-volume sclerosant. The end-points of the study were rebleeding and recurrence of esophageal varices.RESULTS: During a median follow-up period of 16 mo, varices recurred in 1 patient in the combined group as compared with 7 patients in the EVL group (P = 0.045). Rebleeding occurred in 3 patients in the EVL group as compared with 1 patient in the combined group (P = 0.687). No patient died in the two groups. No significant differences were observed between the two groups with respect to serious adverse events.CONCLUSION: Intravariceal-mucosal sclerotherapy using small dose of sclerosant is more effective than EVL in decreasing the incidence of variceal recurrence for cirrhotic patients.