Endoscopic variceal ligation in the management of gastroesophageal varices in postoperative biliary atresia

Currently, endoscopic variceal ligation (EVL) monotherapy is the standard therapy for managing esophageal variceal hemorrhage. Patients generally need several sessions of endoscopy to achieve optimal variceal ablation, and the varices can recur afterward. Endoscopic injection sclerotherapy (EIS) is an older technique, associated with certain complications. This study aimed to evaluate the clinical efficacy of EVL alone versus combined EVL and EIS in the treatment of esophageal varices. This retrospective study included 84 patients, of which 40 patients were treated with EVL monotherapy and 44 patients were treated with combined EVL + EIS. The main outcomes were rebleeding rates, recurrence at six months, number of treatment sessions, length of hospital stay, cost of hospitalization, and procedural complications. At six months, the rebleeding rate and recurrence were significantly lower in the EVL + EIS group compared to the EVL group (2.3% versus 15.0%; and 9.1% versus 27.5%, respectively). The number of treatment sessions, length of hospital stay, and cost of hospitalization were significantly lower in the EVL + EIS group compared to those in the EVL group (2.3 ± 0.6 versus 3.2 ± 0.8 times; 14.5 ± 3.4 versus 23.5 ± 5.9 days; and 23918.6 ± 4220.4 versus 26165.2 ± 4765.1 renminbi, respectively). Chest pain was significantly lower in the EVL + EIS group compared to that in the EVL group (15.9% versus 45.0%). There were no statistically significant differences in the presence of fever or esophageal stricture in both groups. In conclusion, combined EVL + EIS showed less rebleeding rates and recurrence at six months and less chest pain and was more cost effective compared to EVL alone in the treatment of gastroesophageal varices.

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Magnetic resonance angiography versus endoscopy for the assessment of gastroesophageal varices in biliary atresia

Pediatric Surgery International ◽

10.1007/s00383-007-1973-z ◽

2007 ◽

Vol 23 (10) ◽

pp. 931-934 ◽

Cited By ~ 3

Author(s):

Tsubasa Takahashi ◽

Hiroyuki Kobayashi ◽

Ryohei Kuwatsuru ◽

Geoffrey J. Lane ◽

Atsuyuki Yamataka

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Biliary Atresia ◽

Gastroesophageal Varices

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Progression to High-Risk Gastroesophageal Varices in Children With Biliary Atresia With Low-Risk Signs at First Endoscopy

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/mpg.0000000000000710 ◽

2015 ◽

Vol 60 (5) ◽

pp. 664-668 ◽

Cited By ~ 12

Author(s):

Mathieu Duché ◽

Béatrice Ducot ◽

Oanez Ackermann ◽

Emmanuel Jacquemin ◽

Olivier Bernard

Keyword(s):

High Risk ◽

Biliary Atresia ◽

Low Risk ◽

Gastroesophageal Varices

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Experience With Endoscopic Management of High-Risk Gastroesophageal Varices, With and Without Bleeding, in Children With Biliary Atresia

Gastroenterology ◽

10.1053/j.gastro.2013.06.022 ◽

2013 ◽

Vol 145 (4) ◽

pp. 801-807 ◽

Cited By ~ 33

Author(s):

Mathieu Duché ◽

Béatrice Ducot ◽

Oanez Ackermann ◽

Catherine Baujard ◽

Laurent Chevret ◽

...

Keyword(s):

High Risk ◽

Biliary Atresia ◽

Endoscopic Management ◽

Gastroesophageal Varices

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Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Obliterating Gastric Varices. Report of Six Cases and Review of Literature

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v9i2.31049 ◽

2020 ◽

Vol 9 (2) ◽

pp. 89-93

Author(s):

Ajit Thapa ◽

Dinesh Koirala ◽

Rahul Pathak ◽

Dinesh Chataut ◽

Sashi Sharma ◽

...

Keyword(s):

Balloon Catheter ◽

Invasive Procedure ◽

Gastric Varix ◽

Gastric Varices ◽

Minimal Invasive ◽

Balloon Occlusion ◽

Endoscopic Variceal Ligation ◽

Review Of Literature ◽

Gastroesophageal Varices ◽

Novel Method

Portal hypertension results in various complications, gastroesophageal varices being one of them. Although less common than esophageal varices, gastric varices are difficult to obliterate and carry a higher mortality rate when bleeding occurs. They are less amenable to sclerotherapy, endoscopic variceal ligation. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) has been developed as a minimal invasive procedure to obliterate gastric varices. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of gastric varix, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. We report six cases where BRTO was done for gastric varices obliteration.

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Additional Benefits Conferred by Endoscopic Sclerotherapy to Liver Cirrhosis Patients Receiving Endoscopic Variceal Ligation

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/1294410 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Xuni He ◽

Hanqing Chen ◽

Mingming Zhang ◽

Jiemin Hong ◽

Peina Shi

Keyword(s):

Liver Cirrhosis ◽

Portal Vein ◽

Overall Response Rate ◽

Response Rate ◽

Gastric Varices ◽

Endoscopic Sclerotherapy ◽

Endoscopic Variceal Ligation ◽

Short Term ◽

Gastroesophageal Varices

Objective. Gastroesophageal varices are a direct consequence of portal hypertension in cirrhosis. The management of gastroesophageal varices has evolved over the last decade resulting in reduced mortality and morbidity rates. The study was aimed to analyze the short-term and long-term efficacy of different endoscopic methods in the treatment of gastric varices in cirrhotic patients. Methods. From January 2016 to December 2019, 135 patients with liver cirrhosis and gastric varices undergoing different endoscopic treatment protocols were retrospectively analyzed. The patients were divided into three groups according to endoscopic variceal ligation, endoscopic sclerotherapy, and a combination of both, respectively. Main outcomes including the overall response rate, hemostasis, short- and long-term rebleeding (3 months before and after treatment), complication, blood pressure, heart rate, portal venous pressure (PVP), portal vein diameter (PVD), portal vein velocity (PVV), portal vein blood flow (PVF) detected by ultrasound, recurrence rate, and mortality were analyzed after treatments. Results. The overall response rate in the combined group was higher than that in the ligation group and the sclerotherapy group ( P < 0.05 ). The incidence rate of complications in the combined group and the ligation group was lower than that in the sclerotherapy group ( P < 0.05 ). After treatment, the PVP, PVD, and PVF were reduced in the combined group compared with the ligation group and the sclerotherapy group, while the PVV was not ( P < 0.05 ). Lower rates of long-term rebleeding, recurrence, and mortality were noted in the combined group compared to the ligation group and the sclerotherapy group ( P < 0.05 ). Conclusion. Endoscopic variceal ligation combined with endoscopic sclerotherapy is more effective than both alone in treating liver cirrhosis and gastric varices. The combined therapy contributed to reduced short-term and long-term rebleeding rate, decreased long-term recurrence rate, and mortality.

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