Endoscopic embolization combined with variceal ligation in the treatment of gastroesophageal variceal bleeding

Abstract

Objective To explore the therapeutic effect of combined endoscopic embolization and variceal ligation （EVL） for management in cirrhotic patients with gastroesophageal varieeal bleeding. Methods One hundred and fifty-six cases of active gastric fundal variceal bleeding combined with esophageal varices of over degree Ⅱ , and with other causes leading to upper digestive tract bleeding excluded, were randomized into therapeutic group （ n = 80） and control group （ n = 76）. For the therapeutic group, endoscopic eyanoacrylate injection for embolization of gastric fundal varices and EVL for esophageal varices were performed simultaneously. For the control group, EVL was performed 2 months after embolization. Results There was no complication in both groups. The rate of hemostasis in therapy group was 96. 3% （77/80） , and that in control group was 97.4% （ 74/76, P 〉 0. 05 ）. There was significant difference between two groups, regarding the rates of early re-bleeding [ 6. 4% （ 5/78 ） vs 21.3% （ 16/75 ） , P 〈 0. 05 ] and rebleeding at 6 months [ 13.0% （9/69） vs 25.4% （ 17/67）, P 〈0. 05]. There was no significant difference between two groups, regarding the effective rate in disappearance of gastric fundus varices （61.6% vs 59. 1% ）, and in that of esophageal varices （74. 0% vs 67. 9% ）. Conclusion Endoscopic embolization of gastric fundus varices, combined with EVL for esophageal varices, is a safe and effective procedure for the treatment of gastroesophageal variceal bleeding, and it can reduce the rate of re-bleeding. Key words: Esophageal and gastric varices ; Embolization, theraputic ; Ligation ; Endoscopy