Endoscopic Variceal Ligation (EVL) Plus Propranolol (P) and Isosorbide Mononitrate (ISMN) Versus Endoscopic Variceal Ligation Alone in Secondary Prophylaxis of Variceal Bleeding

Portal hypertension refers to a pathological elevation of pressure in the veins that carry blood from the splanchnic organs to the liver which, in developed countries, most commonly results from increased intrahepatic resistance to portal flow as a result of liver cirrhosis. Portal hypertension is associated with development of many of the complications of cirrhosis and confers a poor prognosis. Acute variceal bleeding is a life-threatening medical emergency which remains a leading cause of death in patients with cirrhosis. Endoscopic variceal ligation and endoscopic variceal obturation remain the treatments of choice for bleeding oesophageal and gastric varices respectively. Advances in care including prophylactic antibiotics, vasoactive drugs, and transjugular intrahepatic portosystemic shunt in patients with bleeding refractory to early endoscopic management has improved the mortality rate, which is now estimated at 15 to 20%. Secondary prophylaxis of variceal bleeding with nonselective β‎-blockers and/or endoscopic variceal ligation reduces recurrent bleeding and has been demonstrated to improve survival.

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Sa1596 Efficacy and Safety of Endoscopic Variceal Ligation (EVL) for Primary and Secondary Prophylaxis of Esophageal Variceal Bleeding in an Underserved Population

Gastroenterology ◽

10.1016/s0016-5085(16)31186-6 ◽

2016 ◽

Vol 150 (4) ◽

pp. S337-S338

Author(s):

Courtney Pigott ◽

Nathan Schomaker ◽

Alvaro Martinez-Camacho

Keyword(s):

Variceal Bleeding ◽

Secondary Prophylaxis ◽

Underserved Population ◽

Endoscopic Variceal Ligation ◽

Efficacy And Safety ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding

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Comparison of endoscopic variceal ligation and beta-blocker (carvedilol) plus nitrate for the primary prevention of variceal bleeding

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20173230 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1053

Author(s):

Anilesh Kumar Singh Yadav ◽

Priyadarshi B. P. ◽

Gupta A. C. ◽

Mahendra Singh ◽

Ashok Kumar Verma ◽

...

Keyword(s):

Primary Prevention ◽

Combination Therapy ◽

Beta Blocker ◽

Variceal Bleeding ◽

Beta Blockers ◽

Isosorbide Mononitrate ◽

P Value ◽

Endoscopic Sclerotherapy ◽

Endoscopic Variceal Ligation ◽

Promising Alternative

Background: Esophageal variceal bleed is a major problem in patients with cirrhosis. Endoscopic sclerotherapy and variceal ligation are effective in stopping bleeding in up to 90% of patients. Beta-blocker (Carvedilol) + Isosorbide Mononitrate are promising alternative to other nonselective beta blocker or endoscopic band ligation for the prevention of first variceal bleeding of medium to large varices, which needs to be further explored.Methods: The present study was an observational study in 200 patients at LLR and Associated Hospitals PG Department of Medicine GSVM Medical College, Kanpur. After randomization 120 patients underwent for Endoscopic Variceal ligation and 80 patients were put on beta-blocker (Carvedilol) + Isosorbide Mononitrate therapy for the primary prevention of variceal bleeding.Results: Most common cause of portal hypertension was liver cirrhosis (in carvedilol plus isosorbide mononitrate group 70%, and it was 85%. in EVL group. Bleeding in patients of carvedilol plus isosorbide mononitrate was significantly lower (23.75%) than patients of EVL (60%) group. Reduction in bleeding was statistically highly significant (p value < 0.05). Mortality among patients receiving combination therapy with carvedilol plus isosorbide mononitrate was (12.5%) comparison to EVL (21.66%). Reduction in mortality was statistically not significant. (p value >0.05). Adverse effects were significantly lower among patients receiving combination therapy with carvedilol plus isosorbide mononitrate (38.75%) than patients of EVL (86.66%) group.Conclusions: Both EVL and beta-blockers may be considered first-line treatment to prevent first variceal bleeding, whereas beta-blockers (carvedilol) plus isosorbide mononitrate may be the best choice for the prevention of re-bleeding.

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Endoscopic variceal ligation combined with sclerotherapy for management of gastroesophageal variceal bleeding in pediatric patients

10.21203/rs.3.rs-855914/v1 ◽

2021 ◽

Author(s):

Ming-Ming Li ◽

Fang Sun ◽

Man-Xiu Huai ◽

Chun-Ying Qu ◽

Feng Shen ◽

...

Keyword(s):

Variceal Bleeding ◽

Pediatric Patients ◽

Median Number ◽

Gastric Varices ◽

Secondary Prophylaxis ◽

Endoscopic Management ◽

Endoscopic Variceal Ligation ◽

Variceal Hemorrhage ◽

Clinical Center ◽

The Mean

Abstract Background Portal hypertension (PH) frequently gives rise to severe and life-threatening complications, including hemorrhage accompanied by the rupture of esophageal and gastric varices. In contrast to the widely studied guidelines for the management of PH in adults, there remains controversial about the optimal endoscopic management of variceal bleeding in children for secondary prophylaxis. The study aims to determine the efficacy and safety of endoscopic variceal ligation (EVL) and sclerotherapy (EST) to control bleeding in children in our clinical center. Methods The retrospective study included 21 children with gastroesophageal variceal bleeding who were treated by endoscopic variceal ligation or sclerotherapy at Xinhua Hospital, Shanghai Jiaotong University School of Medicine between January 2007 and July 2020. The treatment outcome involving short-term hemostatic rate and long-term rebleeding rate were investigated. Adverse events related to the procedures, such as esophageal ulcer, esophageal stricture, abnormal embolization, pneumonia and perforation were also observed. Results The 21 pediatric patients who were diagnosed as moderate to severe esophageal varices concurrent with gastric varices experienced EVL or EST successfully. Hemostasis was achieved in 45 of 47 (95.7%) episodes of upper gastrointestinal bleeding. The mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 mL (range: 0.1–0.5 mL). Twenty-four patients (75%) reach varices eradication in the EVL group with a median number of procedures before eradication of 2 (1–4) and a median time to eradication of 3.40 months (1.10-13.33). Eleven patients (52.4%) developed rebleeding events, with the mean duration of hemostasis being 11.1 ± 11.6 mo (range: 1.0-39.2 mo). No treatment-related complications, for example, distal embolism, were noted with the exception of abdominal pain in one patient (4.8%). Conclusions Endoscopic variceal sclerotherapy or in combination with EVL turns out to be an effective and safe approach to treat variceal hemorrhage in children for secondary prophylaxis.

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