A New Method of Endoscopic Variceal Ligation-Injection SclerotherapyEVLIS for Gastric Varices

Endoscopic variceal ligation (EVL) was developed as an alternative to endoscopic variceal sclerosis (ES) because of the latter's high complication rate. The new technique involves placement of small elastic bands around the variceal channels in the distal esophagus. Initial open trials with EVL showed that it was safe and effective therapy for bleeding esophageal varices. EVL can be used emergently to control actively hemorrhaging varices and electively to eradicate varices with repeated sessions. When compareJ directly with results obtained with ES retrospectively and prospectively, EVL is equal or superior in preventing rebleeding while causing many fewer complications. Combining the two techniques may be even more effective than either alone at eradicating varices. Combination therapy has achieved eradication of varices in an average of three sessions, which is one to three fewer sessions than generally reported to achieve eradication with EVL or ES alone. Combination therapy has also been used to control bleeding gastric varices effectively. EVL, alone or with low dose ES, seems to be the safest and most effective endoscopic means for controlling bleeding from esophageal or gastric varices. EVL needs to be evaluated for prophylactic treatment of esophageal varices since its low morbidity profile may make it more suitable than ES for prophylactic treatment.

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Portal hypertension and variceal bleeding

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0319 ◽

2020 ◽

pp. 3068-3080

Author(s):

Marcus Robertson ◽

Peter Hayes

Keyword(s):

Portal Hypertension ◽

Variceal Bleeding ◽

Developed Countries ◽

Gastric Varices ◽

Secondary Prophylaxis ◽

Medical Emergency ◽

Endoscopic Management ◽

Recurrent Bleeding ◽

Endoscopic Variceal Ligation ◽

Complications Of Cirrhosis

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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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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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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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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