The Evolving Role of Endoscopic Treatment for Bleeding Esophageal Varices |
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Authors: | J E J Krige MBChB FACS FRCS FCS J M Shaw MB BCh FCS P C Bornman MB ChB MMed FRCS FRCS FCS |
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Institution: | (1) Department of Surgery and Medical Research Council, Liver Research Center, University of Cape Town Health Sciences Faculty, 7925 Observatory, Cape Town, South Africa;(2) Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa |
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Abstract: | The treatment of acute and recurrent variceal bleeding is best accomplished by a skilled, knowledgeable, and well-equipped
team using a multidisciplinary integrated approach. Optimal management should provide the full spectrum of treatment options
including pharmacologic therapy, endoscopic treatment, interventional radiologic procedures, surgical shunts, and liver transplantation.
Endoscopic therapy with either band ligation or injection sclerotherapy is an integral component of the management of acute
variceal bleeding and of the long-term treatment of patients after a variceal bleed. Variceal eradication with endoscopic
ligation requires fewer endoscopic treatment sessions and causes substantially less esophageal complications than does injection
sclerotherapy. Although the incidence of early gastrointestinal rebleeding is reduced by endoscopic ligation in most studies,
there is no overall survival benefit relative to injection sclerotherapy. Simultaneous combined ligation and sclerotherapy
confers no advantage over ligation alone. A sequential staged approach with initial endoscopic ligation followed by sclerotherapy
when varices are small may prove to be the optimal method of reducing variceal recurrence. Overall, current data demonstrate
clear advantages for using ligation in preference to sclerotherapy. Ligation should therefore be considered the endoscopic
treatment of choice in the treatment of esophageal varices. |
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