Comparison among Endoscopic Variceal Obliteration, Endoscopic Band Ligation, and Balloon-occluded Retrograde Transvenous Obliteration for Treatment of Gastric Variceal Bleeding

Introduction. Endoscopic band ligation (EBL) is superior to endoscopic injection sclerotherapy (EIS) of oesophageal varices, however, EBL is associated with a higher rate of variceal recurrences. Objective. To examine whether the reduction of recurrent varices can be achieved by additional sclerotherapy of remnant little varices after ligation. Methods. Forty-eight patients with liver cirrhosis who had previously bled from oesophageal varices were examined. Endoscopic therapy was performed in order to prevent recurrent variceal bleeding. I group: in 23 patients ligation of oesophageal varices with multi band ligation device was applied (EBL group). II group: in 25 patients sclerotherapy using polydocanol or absolute alcohol was applied after reducing the size of varices using ligation (EBL and EIS group). Results. There was no statistically significant difference between the examined groups of patients in relation to the number of sessions for variceal eradication, recurrence of variceal bleeding, deterioration of portal gastropathy and mortality in the observed period from 18.8?18.6 months (EBL group) and 22.2?26.2 months (EBL and EIS group). Variceal recurrence was verified in 21.7% of patients of the EBL group and 16% of the EBL and EIS group, but the difference was not statistically important. Several complications, such as dysphagia and chest pain, were statistically more frequent in the EBL and EIS group of patients. Conclusion. The combined method of ligation and extra sclerosing of remnant small oesophageal varices after ligation does not have advantage in relation to the ligation alone.

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Sa1482 Clinical Outcomes in Hepatocellular Carcinoma Patients With Esophageal Variceal Bleeding Managed With Endoscopic Band Ligation or Cyanoacrylate Injection

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.05.101 ◽

2014 ◽

Vol 79 (5) ◽

pp. AB229

Author(s):

Raymond S. Tang ◽

Moe Htet Kyaw ◽

Yee Kit TSE ◽

Jessica Ching ◽

Vincent W. Wong ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Clinical Outcomes ◽

Variceal Bleeding ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Band Ligation ◽

Endoscopic Band Ligation

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Clinical outcomes of sedation during emergency endoscopic band ligation for variceal bleeding: Multicenter cohort study

Digestive Endoscopy ◽

10.1111/den.13610 ◽

2020 ◽

Vol 32 (6) ◽

pp. 894-903

Author(s):

Chan Hyuk Park ◽

Se Woo Park ◽

Jang Han Jung ◽

Gyeong Guk Kim ◽

Se Young Choi ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Variceal Bleeding ◽

Multicenter Cohort Study ◽

Band Ligation ◽

Multicenter Cohort ◽

Endoscopic Band Ligation

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Endoscopic band ligation (EBL) vs. non-selective β-blockers in the prevention of first variceal bleeding in cirrhosis: A meta-analysis

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(01)80488-0 ◽

2001 ◽

Vol 53 (5) ◽

pp. AB195 ◽

Cited By ~ 1

Keyword(s):

Variceal Bleeding ◽

Meta Analysis ◽

Band Ligation ◽

Endoscopic Band Ligation ◽

Β Blockers

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Therapies: Drugs, Scopes and Transjugular Intrahepatic Portosystemic Shunt - When and How?

Digestive Diseases ◽

10.1159/000374101 ◽

2015 ◽

Vol 33 (4) ◽

pp. 524-533 ◽

Cited By ~ 4

Author(s):

Juan G. Abraldes ◽

Puneeta Tandon

Keyword(s):

High Risk ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Variceal Bleeding ◽

Portosystemic Shunt ◽

Variceal Hemorrhage ◽

Band Ligation ◽

First Choice ◽

Intrahepatic Portosystemic Shunt ◽

Endoscopic Band Ligation ◽

Β Blockers

Variceal bleeding is the most serious complication of portal hypertension. All cirrhotic patients should be screened endoscopically for varices which are present in about 30% of compensated and 60% of decompensated patients at diagnosis. In patients without varices, endoscopy surveillance should be continued every 2 years. Patients with high-risk varices (moderate or large in size, or with red color signs, or in Child-Pugh C patients) should be treated with a nonselective β-blocker to prevent bleeding (propranolol, nadolol or carvedilol). Endoscopic banding ligation is also effective for the prevention of first bleeding, and it is the first choice in patients with contraindications or intolerance to β-blockers. Acute variceal hemorrhage still has a high mortality rate (around 15%) and requires intensive care management and conservative blood transfusion policy. Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation and prophylactic antibiotics. Failures are best managed by transjugular intrahepatic portosystemic shunt (TIPS). Balloon tamponade or specifically designed covered esophageal stents can be used as a bridge to definitive therapy in unstable patients. Early, preemptive TIPS might be the first choice in patients at high risk of failure (Child-Pugh B with active bleeding or Child-Pugh C up to 13 points). Patients surviving a variceal bleeding are at high risk of rebleeding. A combination of β-blockers and endoscopic band ligation is the most effective therapeutic approach. Preliminary data suggest that the addition of simvastatin increases survival in these patients.

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