Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage: A meta-analysis

AbstractLiver function is a most important prognostic factor in patients with liver cirrhosis. Also, portal hypertension is a fatal complication of liver cirrhosis and variceal treatment is indispensable. However, changes of liver functions after endoscopic variceal treatments are unknown. The aim of this study was to evaluate prognosis and liver functions after endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). A total of liver cirrhotic 103 patients who underwent prophylactic EIS and EVL were enrolled. Overall survival rate was higher in EIS group than EVL group (p = 0.03). Multivariate analysis showed that EIS was a negative factor for death (HR: 0.46, 95% confidence interval: 0.24–0.88, p = 0.02). Liver functions were assessed by blood test taken at before and 3 months after treatment. In EIS group, albumin and prothrombin time improved (p < 0.01), leading to improvement of Child–Pugh score, ALBI score and MELD score (p < 0.05). However, these did not improve in EVL group. EIS was a significant factor related to the elevated value of albumin after treatment in linear regression analysis (estimated regression coefficient: 0.17, 95% confidence interval: 0.05–0.29, p = 0.005). These results revealed that EIS could improve liver functions and prognosis.

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Evaluation of endoscopic variceal ligation in prophylactic therapy for bleeding of oesophageal varices: A prospective, controlled trial compared with endoscopic injection sclerotherapy

Journal of Gastroenterology and Hepatology ◽

10.1046/j.1440-1746.1999.01841.x ◽

2002 ◽

Vol 14 (3) ◽

pp. 241-244 ◽

Cited By ~ 28

Author(s):

Yudai Gotoh ◽

Ryuichi Iwakiri ◽

Yasushi Sakata ◽

Takanori Koyama ◽

Takahiro Noda ◽

...

Keyword(s):

Controlled Trial ◽

Injection Sclerotherapy ◽

Oesophageal Varices ◽

Endoscopic Variceal Ligation ◽

Prophylactic Therapy ◽

Endoscopic Injection Sclerotherapy ◽

Endoscopic Injection

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Esophageal Variceal Ligation Monotherapy versus Combined Ligation and Sclerotherapy for the Treatment of Esophageal Varices

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8856048 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Jianbo Wang ◽

Shenghui Chen ◽

Yehia M. Naga ◽

Junwei Liu ◽

Mugen Dai ◽

...

Keyword(s):

Chest Pain ◽

Hospital Stay ◽

Esophageal Varices ◽

Length Of Hospital Stay ◽

Injection Sclerotherapy ◽

Endoscopic Variceal Ligation ◽

Variceal Hemorrhage ◽

Esophageal Variceal ◽

Gastroesophageal Varices ◽

Number Of Treatment

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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Duodenal Varices: A Rare Manifestation of Portal Hypertension

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v37i3.41738 ◽

2019 ◽

Vol 37 (3) ◽

pp. 156-159

Author(s):

Deepankar Kumar Basak ◽

Richmond Ronald Gomes ◽

Md Samsul Arfin

Keyword(s):

Portal Hypertension ◽

Short Review ◽

Injection Sclerotherapy ◽

Endoscopic Variceal Ligation ◽

Endoscopic Injection ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Duodenal Varices ◽

Vein Thrombosis ◽

Ectopic Varices

We report a case of haematemesis & melaena due to ectopic varices located in the duodenum in a patient with NASH related CLD. Duodenal varices are a rare but potentially serious consequence of portal hypertension in the event of a bleeding. The etiology of duodenal varices can be classified into hepatic (e.g. cirrhosis) or extra hepatic (e.g. portal, splenic or superior mesenteric vein thrombosis). Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are widely accepted as primary therapies for esophageal variceal bleeding whereas bleeding gastric fundal varices are usually treated with cyanoacrylate injection or shunt procedures. However there is no widely accepted treatment modality for duodenal varices. In the case presented, we used injection sclerotherapy with ethanolamine oleate, to obliterate varices and control bleeding. A short review on the etiology pathogenesis and management of ectopic varices is presented. J Bangladesh Coll Phys Surg 2019; 37(3): 156-159

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