内镜密集与非密集套扎治疗重度食管静脉曲张256例

目的:观察内镜密集套扎治疗重度食管静脉曲张的效果.方法:肝硬化门脉高压患者256例,分为2组:A组为密集套扎组130例,B组为非密集套扎组(标准组)126例.分组标准以一次套扎圈<6个为非密集套扎组,>8个为密集套扎组.采用6连发套扎器行内镜治疗.结果:A组首次平均每例患者结扎10.9个点,首次结扎2 wk后复查食管静脉曲张基本治愈(曲张静脉基本消除率)者39例,显效者有43例,有效者20例,无效者7例,总有效率93.58%.平均结扎1.6次.B组食管静脉曲张基本治愈(曲张静脉基本消除率)者7例,显效者有58例,有效者40例,无效者7例,总有效率93.75%,平均结扎2次.结论:食管静脉曲张采用密集套扎法进行连续EVL治疗,静脉曲张消失率高,减少套扎次数,是有效的治疗食管静脉曲张的可靠方法.     

经内镜食管曲张静脉套扎术联合腹腔镜脾切除术治疗门静脉高压症

目的 探讨经内镜食管曲张静脉套扎联合手助腹腔镜脾切除术治疗门静脉高压症的 疗效及安全性。方法 2001年6月至2004年10月,对15例中、重度食管静脉曲张且脾功能亢进患 者先行内镜食管曲张静脉套扎术,待食管静脉曲张消失或降为轻度后1-2周,行手助腹腔镜脾切除 术。结果 每例平均套扎治疗2.2次,套扎后11例食管静脉曲张完全消失,4例静脉曲张由重度降 为轻度。手助腹腔镜脾切除术无严重手术并发症,无中转开腹及死亡病例。术后1周复查,血小板由 术前的(38-67)×10 6／L升至(89-310)×10 6／L,平均随访17.6个月,无上消化道出血。结论 对 于门静脉高压脾功能亢进者,内镜食管曲张静脉套扎术联合手助腹腔镜脾切除术具有微创的优点,安 全、有效。     

内镜套扎联合硬化剂夹心法治疗食管静脉曲张破裂出血的远期疗效观察

[目的]探讨内镜下静脉曲张套扎同时应用硬化剂夹心法(套扎-硬化-套扎即EVL-EVS-EVL)治疗食管静脉曲张破裂出血的疗效。[方法]对23例肝硬化食管静脉曲张破裂出血的患者采用夹心法治疗,每条曲张静脉结扎皮圈不超过3个,并在2个结扎点之间的曲张静脉内注射l~3ml硬化剂。其中10例在首次内镜治疗时接受食管静脉造影检查。于治疗后2周、1个月、3个月、6个月、12个月胃镜随访,了解静脉曲张变化情况,记录患者不良反应及并发症。[结果]10例行静脉造影检查中7例硬化剂在曲张静脉内滞留时间超过40min。夹心法控制活动性食管静脉曲张出血的止血成功率为100%,静脉曲张消除率为86.9%(20/23),再出血发生率为8.6%(2/23),随访期内静脉曲张复发率为13.0%(3/23)。[结论]夹心法能使硬化剂在曲张静脉内滞留较长时间,在一次治疗后能有效提高静脉曲张消除率,降低再出血率及静脉曲张复发率,是内镜下治疗食管静脉曲张破裂出血的较理想选择。     

不同肝功能分级患者食管非密集套扎预后评价

目的 观察内镜下非密集套扎疗法对肝功能B级(Child-Pugh B级)、肝功能C级(Child-Pugh C级)患者食管静脉曲张治疗效果的判断,分析肝功能分级差的患者经套扎治疗后的预后效果是否劣于肝功能分级好的患者。方法 选取2007年至2013年在昆明医科大学第一附属医院收治的肝硬化并食管静脉曲张患者76例,男47例,女29例,平均年龄55岁。试验组：肝功能B级,40例;对照组;肝功能C级,36例,均采用六连发套扎器行内镜下治疗,套扎圈≤6个为非密集套扎。结果 试验组、对照组首次平均套扎次数相比,差异无统计学意义(t=1.551,P=0.125);两组套扎首次治愈相比,差异无统计学意义(χ²=0.085,P>0.05);两组首次套扎总有效率、半年后复查总有效率、1年后复查总有效率、2年后复查总有效率、3年后复查总有效率相比,差异有统计学意义(P<0.05)。结论 肝功能分级的轻重可影响食管静脉曲张套扎患者手术治疗后的预后情况。长远看来肝功能B级患者预后较肝功能C级患者好,临床医师对患者进行静脉曲张套扎治疗前需认真评估肝功能水平。     

内镜下密集套扎法治疗食管静脉曲张破裂出血的效果观察

目的观察内镜下密集套扎法治疗食管静脉曲张破裂出血的临床疗效。方法选取石家庄市第五医院2015年7月-2016年6月因肝硬化门静脉高压食管静脉曲张破裂出血首次行内镜下套扎治疗的156例患者的临床资料,根据治疗方法不同分为密集套扎组(n=76)和非密集套扎组(n=80)。对患者随访观察1~2年,统计患者的静脉曲张根除或基本消失率、套扎次数、早期再出血率、迟发性再出血率及不良反应发生率等。计量资料2组间比较采用t检验;计数资料2组间比较采用χ~2检验或Fisher精确检验。结果密集套扎组与非密集套扎组静脉曲张根除或基本消失率(71.05%vs 55.00%)、套扎次数比较,差异均有统计学意义(χ~2值分别为4.300、8.511,P值分别为0.038、0.014),2组患者早期再出血率(5.26%vs 2.50%)、迟发性再出血率(7.89%vs10.00%)、静脉曲张复发率(13.16%vs 18.75%)及不良反应发生率(26.32%vs 21.25%)比较,差异均无统计学意义(P值均0.05);静脉曲张复发时间比较,差异有统计学意义[(11.90±1.89)个月vs(7.07±1.17)个月,t=2.295,P=0.031]。随访期间,156例患者中共死亡2例(1.28%),其中密集套扎组和非密集套扎组各死亡1例。2组病死率比较,差异无统计学意义(P0.05)。结论内镜下密集套扎法治疗食管静脉曲张破裂出血较安全,静脉曲张消失率及套扎次数优于非密集套扎法,静脉曲张复发晚。     

心得安对食管曲张静脉套扎后再出血的影响

目的:观察心得安对食管曲张静脉套扎后再出血的影响.方法:7 8 例门脉高压性食管静脉曲张(esophageal varices, EV)患者, 分成单独套扎组(39例, 作为对照组)和心得安组(39例, 套扎后给予心得安, 10 mg, 3次/d, po). 比较两组套扎后12 mo内再出血率, 同时12 mo后复查胃镜,比较两组患者门脉高压性胃病及胃底曲张静脉发生率.结果:套扎12 mo后再出血率心得安组明显低于对照组(38.70% vs 54.54%, P<0.05). 心得安组门脉高压性胃病发生率、胃底静脉发生率,食管静脉再发率均明显低于对照组(32.25% vs57.57%, 25.80% vs 42.42%, 29.03% vs 39.39%,均P<0.05).结论:心得安可降低食管曲张静脉套扎后再出血, 其原因是心得安能够降低套扎后的门脉高压性胃病和食管、胃底静脉曲张的发生.     

内镜套扎术联合药物预防食管静脉曲张破裂出血的观察

目的 探讨内镜套扎术联合药物预防食管静脉曲张破裂出血的有效性.方法 将64例肝硬化伴食管静脉曲张破裂出血患者随机分为治疗组33例(内镜套扎术+普萘洛尔+单硝酸异山梨醇酯)和对照组31例(普萘洛尔+单硝酸异山梨醇酯)分别进行治疗,对比两组治疗前后内镜下食管静脉曲张变化、血液动力学监测结果和再出血率等情况.结果 治疗后两组Dpv、Dsv、Qpv、Qsv与治疗前比较均显著下降(P<0.05),Vpv、Vsv治疗前后比较,差异无统计学意义,两组血液动力学监测对比,差异无统计学意义(P>0.05);6个月时治疗组有3例(9%)、对照组有6例(19.4%)再次发生出血,两组再出血率差异有统计学极显著意义(P<0.01),12个月时治疗组共有4例(12.1%)对照组共有11例(35.5%)再次发生上消化道出血,两组再出血率差异仍有统计学极显著意义(P<0.01);64例进行胃镜复查,治疗组6个月时食管静脉曲张轻度或消失为51.5%(17/33),12个月时为48.5%(16/33),对照组6个月和12个月均为3.2%(1/31),由中度变为轻度.结论 内镜套扎术联合药物预防食管静脉曲张破裂出血效果优于单纯药物治疗,且安全、效果明显,病人易接受,可作为预防食管静脉曲张破裂出血的首选方法.     

内镜下套扎术预防晚期血吸虫病食管静脉曲张破裂出血

目的 目的 探讨内镜下套扎术预防晚期血吸虫病 （晚血） 食管静脉曲张再发和破裂出血的作用。方法 方法 治疗组为42 例套扎术后晚血患者, 对照组为同期住院不愿接受套扎治疗的30例晚血患者, 治疗期间3～6个月复查胃镜1次, 了解食管 静脉曲张情况, 并记录有关医疗事件。 结果 结果 套扎治疗后随访2～3年, 平均29个月。治疗组静脉曲张复发8例, 复发率 19.0%, 平均复发时间30个月; 发生食管静脉曲张破裂出血5例, 发生率11.9%, 平均发生时间25个月, 死亡2例。对照组静 脉曲张复发13例, 复发率43.3%, 平均复发时间18个月, 发生出血11例, 发生率36.7%, 平均发生时间18个月, 死亡7例。 治疗组在预防食管静脉曲张破裂出血, 降低病死率方面优于对照组。结论 结论 套扎术可作为预防晚血食管静脉曲张破裂出 血的方法。     

多环与单环橡皮圈套扎在肝硬化食管静脉曲张出血急诊内镜治疗中的疗效比较

目的:观察多环与单环套扎在肝硬化食管静脉曲张(EV)出血急诊内镜治疗后临床疗效的异同。方法:75例急诊内镜诊断为EV或合并胃底静脉曲张上消化道出血患者随机采用多环或单环橡皮圈套扎治疗,分为多环套扎治疗组和单环套扎治疗组。多环套扎治疗组40例,根据EV程度给予单位点2环、3环或4环套扎治疗;单环套扎治疗组35例。合并胃底静脉曲张须先给予硬化剂聚桂醇+组织胶+硬化剂方法注射治疗。单环套扎治疗再出血患者改用多环套扎治疗。结果:多环套扎治疗组治疗后胃镜复查EV完全消失8例,基本消失26例,EV消失率85%;单环套扎治疗组治疗后胃镜复查EV完全消失5例,基本消失15例,EV消失率57%;2组比较存在显著性差异(P<0.05)。1年再出血率多环套扎治疗组为5%,明显低于单环套扎治疗组的23%(P<0.05)。改用多环套扎治疗的再出血患者曲张静脉明显消失。结论:多环套扎治疗EV效果优于单环套扎治疗。     

内镜下套扎联合经皮经肝TH胶栓塞治疗肝硬化食管胃底静脉曲张的临床应用

目的评价内镜下套扎(EVL)联合经皮经肝曲张静脉TH胶栓塞术(PTVE)治疗肝硬化食管胃底静脉曲张出血的远期疗效。方法 44例肝硬化食管胃底静脉曲张出血患者,先行食管曲张静脉的内镜下套扎治疗,1周后再行TH胶PTVE,栓塞食管胃底曲张静脉区域及其来源血管。联合治疗术后定期复查胃镜,观察曲张静脉消失情况,随访治疗后曲张静脉复发率及再出血率。结果 44例食管胃底静脉曲张患者,32例食管曲张静脉基本消失,消失率72.7%;8例胃底静脉曲张基本消失,消失率100%;12例食管静脉曲张程度明显减轻,总有效率100%。随访6~39个月,平均25.6个月,5例食管静脉曲张复发,复发率11.4%;3例再出血,再出血率6.8%。结论内镜下套扎治疗能机械性地消除食管曲张静脉,经皮经肝TH胶栓塞能栓塞食管胃底曲张静脉区域及其供血血管,二者联合能达到协同作用,具有更好的远期疗效。     

Endoscopic treatment of esophageal varices, using pretied loop made with polyamide thread

BACKGROUND: [corrected] The elastic band ligation is the method of choice for treatment of esophageal varices. The action mechanism is a mechanical varices compression with thromboses. Based on this concept we developed a ligature method using pretied loop made with polyamide thread for the treatment of esophageal varices. OBJECTIVE: The present study describes and evaluates the feasibility of the treatment of esophageal varices by the ligature method using pretied loop made with polyamide thread and analyzes the local changes of the ligations and the results, concerning safety, efficiency and complications of this procedure. PATIENTS AND METHODS: Between March, 1998 and May, 2000, 58 patients with esophageal varices were treated with pretied loop, made with polyamide thread (26 patients with schistosomiasis, 11 with alcoholic cirrhosis, 9 with hepatitis C, 5 with hepatitis B, 4 of unknown etiology, 2 with hepatitis B and C, and one with Budd-Chiari syndrome/ 42 men and 16 women/ average age of 47,67 +/- 13,12 years, range 16-74). A plastic tube was attached to the endoscope tip featured as an accessory working channel, allowing the pretied loop made with polyamide thread to be conducted to the esophagus facilitated by a flexible metallic tube, to perform the esophageal varices ligature. A total of 506 ligatures were done, distributed in 223 sections (average of 2,26 +/- 1,08 ligature, varying from 1 to 6 per section). The sessions were perform with the interval of 15 days, until the complete eradication of the esophageal varices. The ecoendoscopy was used as a complementary method to evaluate the varices eradication RESULTS: The esophageal varices were treated successfully in all patients. The complete eradication of varices was achieved in 47 (81,03%) patients. In 37 (63,79%) patients the ligatures resulted in pseudopolyps. It was not identified systemic complications or obits. The ecoendoscopy showed thrombosis in the pseudopolyps of 10 patients. The follow-up period was from 4 to 32 months and recurrence of the esophageal varices was observed in 9 (15,51%) patients. The average cost of each ligature was estimated in US$ 1,00. CONCLUSION: The study indicates that endoscopic treatment using polyamide thread ligature is a safe, efficient, accessible and low cost method for treatment of esophageal varices treatment, demonstrating a new aspect, that is the obliteration of varices without necrosis, by formation of pseudopolyps.     

食管静脉曲张密集结扎术和硬化及结扎联合术的疗效对照观察

比较内镜下食管静脉曲张密集结扎术和内镜下硬化及结扎联合术治疗食管静脉曲张破裂出血的疗效。４２例食管静脉曲张破裂出血病情稳定的病人分为两组，２２例患者接受ＤＥＶＬ，２０例病人行ＥＳ＋ＥＶＬ，两组具有可比性（Ｐ＞０．０５）。第１次治疗，ＤＥＶＬ组每个病人平均结扎１１．３２个点，每根曲张静脉平均结扎２．８３个点；ＥＳ＋ＥＶＬ组首先静脉内注射硬化剂，然后行结扎，第１次治疗平均每根曲张静脉注射硬化剂１．０３次（点），结扎１．０１个点。结果：第１次治疗后，ＤＥＶＬ组食管静脉曲张消失率为５０％，ＥＳ＋ＥＶＬ组为３５％，两组比较无统计学意义（Ｐ＞０．０５）；第１、４、１２及２４周的再出血率，ＤＥＶＬ组为４．５％、４．５％、４．５％、４．５％，ＥＳ＋ＥＶＬ组为１０％、１５％、１５％、２５％，两组无显著差别（Ｐ＞０．０５）。ＤＥＶＬ和ＥＳ＋ＥＶＬ均为治疗食管静脉曲张破裂出血、根除食管静脉曲张的有效方法，ＤＥＶＬ的操作较容易、并发症较少、再出血率较低，内镜下食管静脉曲张密集结扎术将取代内镜下硬化剂注射疗法，成为治疗食管静脉曲张破裂出血的首选方法。     

改良结扎法治疗食管静脉曲张的探索

目的观察改良食管静脉曲张结扎法治疗食管静脉曲张的疗效。方法将30例食管静脉曲张病人随机分为2组,每组15例,分别采用改良结扎法和传统结扎法治疗,对照分析两种结扎方法首次结扎使用橡胶圈的数量、静脉曲张消失时间、静脉曲张复发时间。结果改良结扎法较传统结扎法首次使用橡胶圈数量多(t=5.205,P<0.01);改良结扎法食管静脉曲张消失时间晚(t=6.321,P<0.01),但复发晚(t=6.724,P<0.01)。结论改良结扎法与传统方法相比,治疗食管静脉曲张更彻底,是一种较好的治疗食管静脉曲张的方法。     

Prophylactic banding ligation of high-risk esophageal varices in patients with cirrhosis: a prospective, randomized trial.

BACKGROUND/AIMS: Injection sclerotherapy has been used to prevent the first episode of variceal hemorrhage, but the results are controversial. The value of banding ligation in the prophylaxis of the first episode of variceal bleeding has not yet been completely evaluated. This study was conducted to determine whether prophylactic banding ligation is beneficial for cirrhotic patients with high-risk esophageal varices. METHODS: A total of 127 cirrhotic patients with endoscopically-assessed high-risk esophageal varices but no history of bleeding were randomized to undergo banding ligation (64 patients) or to serve as controls (63 patients). Ligation was performed at 3-week intervals until variceal obliteration was obtained. RESULTS: During a median follow-up of 29 months, 14 patients (21.8%) in the ligation group and 22 patients (34.9%) in the control group experienced upper gastrointestinal bleeding (p = 0.15). Variceal bleeding occurred in eight patients (12.5%) in the ligation group and 14 patients (22.2%) in the control group (p = 0.22). Blood transfusion requirements were fewer in the EVL group than in the control group (0.6+/-0.4 units vs. 1.2+/-0.8 units, p<0.001). Furthermore, variceal bleeding was significantly reduced in Child-Pugh class B patients treated with ligation compared with the control group (p<0.05). Sixteen patients (25%) in the ligation group and 23 patients (36.5%) in the control group died. Comparison of Kaplan-Meier estimates of time to death for the two groups did not show significant differences (p = 0.19). More patients died of uncontrollable variceal bleeding in the control group (7 patients, 11%) than in the ligation group (3 patients, 4.7%) (p = 0.15). CONCLUSIONS: Although prophylactic ligation did not significantly reduce the first episode of bleeding from esophageal varices in cirrhotic patients with high-risk esophageal varices, a subgroup of patients (Child-Pugh class B) had a reduced frequency of the first episode of esophageal variceal bleeding after prophylactic banding ligation. Furthermore, there was a trend of reducing mortality from variceal bleeding in patients receiving prophylactic ligation. Prophylactic ligation is a promising treatment, but requires further investigation.     

Long-term follow-up of patients with liver cirrhosis after endoscopic esophageal varices ligation therapy: comparison with ethanol injection therapy

BACKGROUND/AIMS: Esophageal variceal hemorrhage is the most dreaded complication of liver disease. Prevention or emergency therapy of bleeding is important. METHODOLOGY: A group of 217 patients underwent endoscopic esophageal variceal therapy including endoscopic ethanol injection, endoscopic esophageal variceal ligation, or a combination of the two. RESULTS: Esophageal varices were eradicated by endoscopic esophageal variceal ligation with the least sessions required, and associated complications with endoscopic esophageal variceal ligation therapy were lower than with the other two approaches. However, the cumulative recurrence-free period of esophageal varices was significantly higher after endoscopic ethanol injection than after endoscopic esophageal variceal ligation and in some cases F3 varices were observed post-endoscopic esophageal variceal ligation hemorrhage. A combined endoscopic esophageal variceal ligation and endoscopic ethanol injection therapy had no advantage with respect to cumulative recurrence-free rate, session number, or complication frequency, relative to either therapy alone. CONCLUSIONS: While the combined observations indicate that endoscopic esophageal variceal ligation is safe and simple, we should consider additional therapy to achieve complete mucosal fibrosis of the esophagus after endoscopic esophageal variceal ligation.     

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 management for bleeding esophageal varices: sclerotherapy versus sclerotherapy plus band ligation versus band ligation alone. One year experience at a main hospital in Saudi Arabia.

BACKGROUND/AIMS: This study was done retrospectively to compare the outcome of sclerotherapy alone, band ligation alone and band ligation alternating with sclerotherapy in treatment of esophageal varices. METHODOLOGY: During 1 year 30 patients were admitted with variceal bleeding. They received either injection sclerotherapy (8 patients) or band ligation (11 patients), and 11 patients had a combination of both either during first bleed or during follow-up therapy, which is more than 2 sessions in each group. RESULTS: The success rate for stopping first bleeding was 100% in the band ligation and sclerotherapy alone group. The rebleeding rate was 27% in the combination group, 9% in the band ligation group, and none had rebleeding in the sclerotherapy group during follow-up. Eradication of varices was observed in 33% of patients after a second set of sclerotherapy and band ligation. CONCLUSIONS: Our study showed no significant difference between sclerotherapy versus band ligation in stopping initial bleeding or eradication of varices during the follow-up period, but there was a difference in re-bleeding rates among the three groups.     

A randomized, controlled trial of banding ligation plus drug therapy versus drug therapy alone in the prevention of esophageal variceal rebleeding

Background & Aims:  Both medications with beta-blockers and isosorbide-5-mononitrate and endoscopic variceal ligation have been proven plausible in the prevention of variceal rebleeding. However, the relative efficacy and safety of the combined treatment for preventing rebleeding remains unresolved.
Methods:  Patients with history of esophageal variceal bleeding were enrolled. Emergency ligation was performed in patients with acute variceal bleeding. After hemodynamic stability, eligible patients were randomized to either the Medication group, using nadolol plus isorsorbide-5-mononitrate, or the Combined group, receiving banding ligation in addition to medications. Patients in the two groups with rebleeding from esophageal varices were treated with band ligation. The end points were rebleeding from varices or death.
Results:  After a median follow up of 23 months, recurrent upper gastrointestinal bleeding developed in 51% in the Medication group and 38% in the Combined group ( P  = 0.21). Recurrent bleeding from esophageal varices occurred in 26 patients (43%) in the Medication group and in 16 patients (26%) in the Combined group ( P  = 0.07). Recurrent bleeding from gastroesophageal varices occurred in 48% of Medication group and 28% of Combined group ( P  = 0.05). The frequency of adverse effects and mortality rates were similar between both groups ( P  = 0.28).
Conclusions:  Combined ligation with medications was marginally more effective than medication alone in the prevention of gastroesophageal variceal rebleeding with similar adverse effects and mortality.     

Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis

BACKGROUND: The value of band ligation for prevention of the first episode of variceal bleeding has not been fully evaluated. This study compared the efficacy and safety of band ligation vs. treatment with a beta-blocker for the prophylactic prevention of first bleeding in patients with cirrhosis and high-risk esophageal varices. METHODS: A total of 100 patients with cirrhosis and endoscopically determined high-risk esophageal varices but no history of bleeding were randomized to band ligation (50 patients) or treatment with nadolol (50 patients). In the ligation group, two to 4 elastic bands were deployed during each session. Ligation was repeated at intervals of 3 to 4 weeks until variceal obliteration was achieved. In the nadolol group, the dose of the drug, administered once daily, was sufficient to reduce the pulse rate by 25%. RESULTS: In the ligation group, variceal obliteration was achieved in 41 patients (82%), at a mean of 2.7 (1.1) ligation sessions. In the nadolol group, the mean daily dose of nadolol administered was 60 (20) mg. During follow-up (median approximately 22 months), 10 patients (20%) in the ligation group and 16 (32%) in the nadolol group had upper-GI bleeding (p=0.23). Esophageal variceal bleeding occurred in 5 patients (10%) in the ligation group and 9 (18%) in the nadolol group (p=0.31). By multivariate Cox analysis, Child-Pugh class was the only factor predictive of variceal bleeding. Minor complications were noted in 9 patients (18%) in the ligation group and 4 (8%) in the nadolol group (p=0.35). No serious complication was encountered. Twelve patients in the ligation group and 11 in the nadolol group died (p=0.62). One patient in the ligation group and 3 in the nadolol group died from uncontrollable variceal hemorrhage. CONCLUSIONS: Variceal ligation is as effective and as safe as treatment with nadolol for prevention of first variceal bleeding in patients with cirrhosis.     

Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices

BACKGROUND: Endoscopic sclerotherapy is an absolute indication for treating esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated. AIM: To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation. PATIENTS AND METHOD: Forty-six patients with liver cirrhosis and esophageal varices were prospectively randomized into two treatment groups: endoscopic sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. Informed writing consent was obtained from every patient and the Ethics Committee of Federal University of S?o Paulo, SP, Brazil, approved the study. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence. RESULTS: Both groups were similar except that male gender was more common in the sclerotherapy group. There was no statistical difference regarding variceal eradication (78.3% in sclerotherapy group vs 73.9% in the ligation group), recurrence (26.7% vs 42.9%, respectively) and death related to any cause (21.7% vs 13.9%). In the sclerotherapy group more sessions were need to obtain complete variceal eradication. In this group we did observe a high re-bleeding rate (34.8%) and more ulcers associated with retrosternal pain right after the procedure. There was no difference regarding overall morbidity and mortality. CONCLUSIONS: Banding ligation requires fewer sessions than sclerotherapy with absolute alcohol to eradicate esophageal varices. Both methods are equally efficient regarding variceal eradication and recurrence during a short follow-up period.