Percutaneous transhepatic variceal embolization with cyanoacrylate versus endoscopic ligafion in management of esophageal variceal bleeding

Abstract

Objective To compare the therapeutic effect of percutaneous transhepatic variceal embolization （VINE） with Cyanoaerylate （TH glue） with that of endoscopic varieeal ligation （EVL） in the treatment of esophageal variceal bleeding. Methods In this prospective randomized controlled trial, cirrhotic patients with acute or recent esophageal variceal bleeding were assigned randomly to PTVE （n = 52 ） or EVL （n = 50） groups. Variants including upper gastrointestinal （UGI） re-bleeding, esophageal variceal rebleeding, relapse of esophageal varices and survival were evaluated. Results During the follow-up （ median 24 and 25 months in the PTVE and EVL groups, respectively）, UGI re-bleeding developed in 8 patients （ 15.4% ） in PTVE group and in 21 （42%） in EVL group （ χ^2 = 8. 87, P = 0. 005 ）. Recurrent esophageal varices bleeding occurred in 3 patients （5.8%） in PTVE group and 12 （24%） in EVL group （χ^2 =5.38, P =0. 012, relative risk 0. 24, 95% confidence interval 0. 05 -0. 74）. Reccurent rates of esophageal varices in two groups were 17. 3% （9/52） and 52% （26/50）, respectively （χ^2 = 13.61, P 〈 0. 001 ）. There was no significant difference in survival rate between two groups （ χ^2 = 3.30, P = 0. 054 ）. Conclusion With sufficient embolization of lower esophageal and peri-esophageal varices and/or the cardial submucosal and perforating vessels, PTVE was more effective than EVL in the management of esophageal varices recurrence and re-bleeding. Key words: Esophageal varices; Percutaneous transhepatic variceal embolization; TH glue; Endoscopy varieeal ligation