202 Endoscopic variceal band ligation in comparison with propranolol in prophylaxis of first variceal bleeding in patients with liver cirrhosis

: A 55-year-old male with a 7-year history of liver cirrhosis was admitted to our department due to recurrent hematemesis and melena. He had been treated with endoscopic tissue glue injection and/or band ligation for gastroesophageal variceal bleeding. He denied any history of viral hepatitis infection or alcohol abuse. At this admission, his pulse rate was 88b.p.m., and blood pressure was 110/51mmHg. Hemoglobin concentration was 81g/L, platelet count was 38X109/L, total bilirubin was 28.4umol/L, and albumin was 24.2g/L. Except for ascites, splenomegaly, and portal vein thrombosis, contrast-enhanced computed tomography scans showed high density within gastric fundal varices, gastro-renal shunt, left renal vein, and inferior vena cava (arrows), suggesting a diagnosis of ectopic embolism from tissue glue injected during a prior endoscopic procedure. Upper gastrointestinal endoscopy demonstrated esophageal varices, post-endoscopic gastric fundal glue removal, and portal hypertensive gastropathy. Esophageal variceal ligation was performed. After that, he was discharged without any other complaints. Currently, endoscopic variceal therapy, mainly including variceal band ligation, sclerotherapy, glue injection, and haemostatic powder spraying is the mainstay treatment option of acute variceal bleeding in liver cirrhosis [1]. There is a benefit of endoscopic glue injection for gastric fundal variceal bleeding in terms of increasing the rate of initial hemostasis and reducing the rate of rebleeding as compared to variceal band ligation [2-3]. Therefore, endoscopic glue injection has been widely employed in cirrhotic patients with gastric variceal bleeding. However, there are some severe complications related to endoscopic glue injection [4-5], especially thromboembolism. The current case further showed a possibility of asymptomatic ectopic embolism after endoscopic glue injection, suggesting that a close surveillance of embolism within portosystemic collateral vessels should be necessary.

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Multicenter prospective randomized controlled trial comparing propranolol, endoscopic band ligation, and combination therapy for the primary prophylaxis variceal bleeding in patients with liver cirrhosis

Journal of Hepatology ◽

10.1016/s0168-8278(17)30330-6 ◽

2017 ◽

Vol 66 (1) ◽

pp. S35 ◽

Cited By ~ 3

Author(s):

Y.S. Seo ◽

M.Y. Kim ◽

H.J. Yim ◽

H.S. Kim ◽

S.G. Kim ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Liver Cirrhosis ◽

Combination Therapy ◽

Variceal Bleeding ◽

Controlled Trial ◽

Primary Prophylaxis ◽

Band Ligation ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Endoscopic Band Ligation

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Endoscopic band ligation for transverse colonic variceal bleeding: case report and review of the literature

Annals of Saudi Medicine ◽

10.5144/0256-4947.2020.255 ◽

2020 ◽

Vol 40 (3) ◽

pp. 255-258

Author(s):

Shan Xie ◽

Ming Fang Ruan ◽

Jiang Wang ◽

Min Bi Li

Keyword(s):

Liver Cirrhosis ◽

Variceal Bleeding ◽

Abdominal Distension ◽

Hepatic Flexure ◽

Gastroesophageal Varices ◽

Acute Bleeding ◽

Band Ligation ◽

Colonic Varices ◽

Communicating Branch ◽

Endoscopic Band Ligation

ABSTRACT Colonic varices are lesser-known in comparison with gastroesophageal varices in a complication associated with liver cirrhosis. The ideal therapeutic intervention for a colonic varix is still unclear. We report a 42 year-old man with 20 years of alcohol use who presented with hematochezia and abdominal distension. The patient was diagnosed with alcoholic liver cirrhosis. The colonoscopy revealed a dilated and tortuous varix in the transverse colon close to the hepatic flexure with oozing blood, a communicating branch and with “red sign”, evidence of acute bleeding. Endoscopic band ligation (EBL), the most useful intervention for esophageal varices, was further successfully performed to arrest the bleeding colonic varices. One month after initial treatment, the colonic varices nearly vanished and were replaced by an ulcer. It is extremely rare for colonic varices to be treated with EBL. There is only one similar case in reported literature, but it seems to be safe and effective as an intervention for EBL for acute colonic variceal bleeding. SIMILAR CASES: Second case treated by endoscopic band ligation.

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Study protocol for a randomised controlled trial of carvedilol versus variceal band ligation in primary prevention of variceal bleeding in liver cirrhosis (CALIBRE trial)

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2019-000290 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000290 ◽

Cited By ~ 2

Author(s):

Dhiraj Tripathi ◽

Peter Clive Hayes ◽

Paul Richardson ◽

Ian Rowe ◽

James Ferguson ◽

...

Keyword(s):

Liver Cirrhosis ◽

Variceal Bleeding ◽

Beta Blockers ◽

Controlled Trial ◽

Major Complication ◽

Oesophageal Varices ◽

Open Label ◽

Band Ligation ◽

Reference Number ◽

Randomised Controlled

IntroductionLiver cirrhosis is the fifth largest cause of adult deaths, and a major complication, variceal bleeding is associated with a 1-year mortality of 40%. There is uncertainty on the first-line therapy for prevention of variceal bleeding owing to a lack of adequately powered trials comparing non-selective beta blockers, in particular carvedilol, with variceal band ligation.Methods and analysisCALIBRE is a multicentre, pragmatic, randomised controlled, open-label trial with an internal pilot. The two interventions are carvedilol 12.5 mg od or variceal band ligation (VBL). Patients with liver cirrhosis and medium to large oesophageal varices that have never bled are eligible for inclusion. The primary outcome is any variceal bleeding within 1 year of randomisation. Secondary endpoints include time to variceal bleed, mortality, transplant-free survival, adverse events, complications of cirrhosis, health-related quality of life, use of healthcare resources, patient preference and use of alternative or crossover therapies. The sample size is 2630 patients over a 4-year recruitment period, across 66 hospitals in the UK.Ethics and disseminationThe study has been approved by a National Health Service (NHS) Research Ethics Committee (REC) (reference number 18/NE/0296). The results of this trial will be submitted for publication in a peer reviewed journal. Participants will be informed via a link to a preview of the publication. A lay summary will also be provided via email or posted to participants prior to publication (ISRCTN reference number: 73887615).

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Carvedilol versus variceal band ligation in primary prevention of variceal bleeding in liver cirrhosis

http://isrctn.com/ ◽

10.1186/isrctn73887615 ◽

2018 ◽

Author(s):

Khaled Ahmed

Keyword(s):

Liver Cirrhosis ◽

Primary Prevention ◽

Variceal Bleeding ◽

Band Ligation

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Impact of Portal Vein Thrombosis on Endoscopic Variceal Band Ligation in Liver Cirrhosis

Journal of Healthcare Engineering ◽

10.1155/2021/9929333 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Yue Huang

Keyword(s):

Liver Cirrhosis ◽

Gastrointestinal Bleeding ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Variceal Bleeding ◽

Band Ligation ◽

Vein Thrombosis ◽

End Point ◽

Retrosternal Pain ◽

The Impact

Background. Portal vein (PV) thrombosis (PVT) is a common complication of liver cirrhosis and can refer to thrombosis within the PV that can extend to its left or right branches and in some cases to the superior mesenteric vein or the splenic vein (Chawla and Bodh, 2015). For severe PVT patients, there are possibilities of increasing PV resistance and reduction of the blood flow though PV towards liver, which exacerbate liver function damage meanwhile elevating the gastrointestinal variceal bleeding risk. Endoscopic Variceal band ligation (EVL) is often used to prevent esophageal variceal bleeding; postoperative complications such as severe gastrointestinal bleeding and bleeding-related death, fever, retrosternal pain, and esophageal stenosis may appear. There was absence of the research which evaluated the impact of PVT in liver cirrhosis on the complication of endoscopic Variceal band ligation for now. We herein aimed to compare cirrhosis patients with and without PVT of recent complications after EVL. Method. We established the retrospective investigation on 144 consecutive cirrhosis patients (excluding patients with hepatocellular carcinoma and who received portal vein-systemic circulation devascularization or shunt surgery, splenectomy, hepatectomy, liver transplantation, transjugular intrahepatic portal vein stent shunt (TIPS), endoscopic varices Variceal ligation, or sclerotherapy before) who have received first endoscopic esophageal varices band ligation in Gastrointestinal Endoscopy Center of the First Affiliated Hospital, College of Medicine, ZheJiang University, between January 2014 and December 2017. Portal vein Doppler ultrasonography, liver computerized tomography (CT), and angiography or liver-enhanced magnetic resonance imaging (MRI) were applied to evaluate the portal vein thrombosis of each patient before EVL. There were 18 patients confirmed with portal vein thrombosis while the other 126 patients without PVT. The primary end point for this research is the upper gastrointestinal hemorrhage and related death occurred from the date of ligation until leaving hospital, and the secondary end point is the appearance of postoperative fever and retrosternal pain. Results. There are no significant differences of gastrointestinal bleeding, bleeding-related death, fever, or retrosternal pain after EVL and the length of hospital stays between cirrhotic patients with or without PVT ( P = 0.34 , 0.51 , 0.58 , 0.61 , 0.88 ). Conclusion. Liver cirrhosis with portal vein thrombosis did not increase incidence of recent complications of the endoscopic Variceal band ligation.

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