Comparison of Endoscopic Variceal Ligation with Endoscopic Sclerotherapy for Secondary Prophylaxis of Variceal Hemorrhage: A Randomized Trial.

H Sakthivel,Sakthivel Chinnakkulam Kandhasamy,Anandhi Amaranathan,Mangala Goneppanavar,Ashok Kumar Sahoo,Vishnu Prasad Nelamangala Ramakrishnaiah

doi:10.7759/cureus.2977

Abstract

BackgroundThough endoscopic variceal ligation (EVL) is commonly being used and has overcome the disadvantages of sclerotherapy (ST), still sclerotherapy is used as a therapeutic procedure for bleeding esophageal varices in the present institute. Hence, the study was done to see the advantages of EVL over ST.MethodsPatients with portal hypertension and bleeding esophageal varices underwent banding if found to have grade 3 or 4 varices. They were randomized to EVL group, where they were reviewed after two weeks for any residual varices for which repeat banding was done and endoscopic sclerotherapy (EST) group, where ST was done until the varices were obliterated or reduced to grade 1. The efficacy, complications, recurrent bleeding rate and recurrence of varices were compared.ResultsA total of 60 patients were included, 30 in each group. In EVL group, four sessions were needed to eradicate the varices in 73% of patients while it was five sessions in EST group (46% patients) (p-value = 0.0001). The mean number of sessions needed in EVL and EST group was 3.73 and 5.36, respectively. The average time taken for eradication of varices was 78.6 and 134.6 days in EVL and EST group, respectively (p-value = 0.004). Complications were higher in EST group (p-value < 0.05).ConclusionEVL alone was effective than ST in terms of the number of sessions needed for eradication of varices and total duration required to completely obliterate them. The complications were less in EVL group with no significant difference in recurrent bleeding rate and recurrence of varices between the groups.

Highlights

The life-threatening complication of portal hypertension is gastroesophageal variceal haemorrhage
Though endoscopic variceal ligation (EVL) is commonly being used and has overcome the disadvantages of sclerotherapy (ST), still sclerotherapy is used as a therapeutic procedure for bleeding esophageal varices in the present institute
Patients with portal hypertension and bleeding esophageal varices underwent banding if found to have grade 3 or 4 varices. They were randomized to EVL group, where they were reviewed after two weeks for any residual varices for which repeat banding was done and endoscopic sclerotherapy (EST) group, where ST was done until the varices were obliterated or reduced to grade 1

Summary

Introduction

The life-threatening complication of portal hypertension is gastroesophageal variceal haemorrhage. The overall mortality is reported to be 30–50% and one-year mortality rate is as high as 70%. The frequency of variceal haemorrhage occurs at the rate of 5– 15% and the strongest predictor of the bleeding is the size of varices. Larger varices have a higher risk of bleeding than smaller varices [1]. Endoscopic sclerotherapy (EST) and endoscopic variceal ligation (EVL) are the two most common endoscopic techniques used for the management of oesophageal varices. EST has largely been replaced by EVL in the management of bleeding varices [2]. Though endoscopic variceal ligation (EVL) is commonly being used and has overcome the disadvantages of sclerotherapy (ST), still sclerotherapy is used as a therapeutic procedure for bleeding esophageal varices in the present institute. The study was done to see the advantages of EVL over ST

Methods

Discussion

Conclusion