7222 The white ball sign and the efficacy of hemostasis in active variceal bleeding.

Abstract

Background: Recently, the white ball sign appearance has been documented during ligation of active esophageal and esophagogastric variceal bleeding(1,2). Until this moment, the efficacy of the white ball sign in regard of hemostasis is unknown. Material and Methods:We included since 05/98 to 10/99, all the patients (pts.) presented with active spurting variceal bleeding and the ligation procedure performed in the first 6 hours of admission. We studied; age, gender,liver disease diagnosis,functional liver status (Child-Pugh),the esophageal variceal size, according to the Japanese Research Society for Portal Hypertension, procedure success and complications. We excluded the pts. with gastric variceal bleeding or the pts. in which the ligation procedure could not be performed. We eliminated the pts. who did not complete a 7 days follow up.The ligation procedure was performed with the Saeed six shooter device from Wilson-Cook and the technique described by Stiegmann. Any other hemostasis modality was not used.Results. We included 24 pts. with active spurting variceal bleeding, esophageal varices 16 pts., esophagogastric varices 7 pts. and one patient with gastric varices. Three pts. were excluded, one with gastric varices, one with esophageal varices and one with esophagogastric varices, the last two because the ligation procedure could not be performed.One patient was eliminated because of spontaneus bacterial peritonitis at admission and she died of sepsis 48 hours later.We studied 20 pts.; 16 male, 4 female, with a mean age of 46.2 years old. Eighteen pts. had hepatic cirrhosis;alcoholic 10 and unknown liver disease 8. One patient had liver metastasis and another with hepatocarcinoma.The Child-Pugh status was A6, B7, C7 pts. The variceal size was “straight”(F2)6 pts., “nodular beaded”(F3)14 pts.In all the pts.after ligation the active spurting variceal point the white ball sign was recorded. None patient had cardiopulmonary complications or recurrent variceal bleeding. Conclusions: The white ball sign occurred in all the pts. with active spurting esophageal and esophagogastric variceal bleeding after ligation. The success rate of the procedure was 87.5%. None pts. rebleed in the 7 days of follow up. In our study the appeareance of the white ball sign has a high correlation in regard of hemostasis efficacy. More studies are needed to corroborate our findings. 1.-Matsutani S.Gastrointest Endosc.98;47:254 2.-Gonzalez JA.Gastrointest Endosc.2000;51 in press.