Endoscopic Esophageal Variceal Ligation Research Articles

Comparison of the Jcerity endoscoper airway and the endotracheal tube in endoscopic esophageal variceal ligation: a prospective randomized controlled trial

Various airway techniques have been used in endoscopic esophageal variceal ligation (EVL). In this respect, Jcerity endoscoper airway (JEA) is a novel laryngeal mask airway that is designed for use in gastrointestinal endoscopy. In the present study, 164 patients who underwent EVL were randomly divided into JEA group or endotracheal tube (ETT) group (ratio: 1:1). Success rate of endoscopic procedure, endoscope insertion time, procedure duration, recovery time, airway technique extubation time, anesthesia costs, hospital stay duration, complications, and hemodynamic parameters were recorded. The success rate of EVL in the JEA group was noninferior to that in the ETT group (98.8% vs. 100.0%). The airway insertion time, anesthesia duration, and recovery time were significantly shorter in the JEA group than in the ETT group (p < 0.001). Furthermore, the blood pressure during extubation was more stable in the JEA group (p < 0.001). Moreover, there were less heart rate variations during intubation (p < 0.005) and extubation (p < 0.05) in the JEA group. Nonetheless, the endoscopists’ satisfaction scores were comparable between the two groups. Overall, our findings suggest that JEA is efficient and safe for clinical use in EVL.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000031892, Registered April 13, 2020, https://www.chictr.org.cn/searchproj.html.

Optimality of 2-week Versus 4-week Intervals in Secondary Prophylaxis of Bleeding by Endoscopic Esophageal Variceal Ligation

Optimality of 2-week Versus 4-week Intervals in Secondary Prophylaxis of Bleeding by Endoscopic Esophageal Variceal Ligation

Early vs Delayed Feeding after Endoscopic Esophageal Variceal Ligation: A Systematic Review and Meta-Analysis

Early vs Delayed Feeding after Endoscopic Esophageal Variceal Ligation: A Systematic Review and Meta-Analysis

Attention to the surgical treatment of portal hypertension in China

Portal hypertension caused by liver cirrhosis is common and severely threatens the patients′ health. The dominant position of the conventional surgical treatment was strongly challenged by the pharmacological, endoscopic esophageal variceal ligation (EVL), transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation. So, what the prospect of surgical treatment is and whether it has disappeared? In fact, the surgical treatment is not only far from disappearing, but also play a unique and indispensable role, and could not be displaced by other treatments. Nowadays, the laparoscopic pericardial devascularization is widespread used, shows the increasingly prominent and distinct advantages of less injury and bleeding, fewer complications and faster recovery. The generalizing of multidisciplinary treatment (MDT) will combine advantages of varies subjects then provide the individual and precise diagnosis and treatment plan to patients. Authors should pay attention to the problems and then organize the clinical multicenter RCT studies, provide high level evidences, explore new surgical procedures, compose new clinical guidelines and consensuses which consistent with our national situations, thus to guide the clinical practice and will further improve the treatment of portal hypertension and raise our country′ voice in this subject. Key words: Portal hypertension; Surgical procedures, operative; Standardization; Individuation

Su1473 - Patients Who do not Receive a Repeat Endoscopy after Initial Endoscopic Esophageal Variceal Ligation have an Increased Risk of Death

Su1473 - Patients Who do not Receive a Repeat Endoscopy after Initial Endoscopic Esophageal Variceal Ligation have an Increased Risk of Death

Clinical efficacy of endoscopic esophageal variceal ligation in elderly patients with hepatic cirrhosis

Objective To evaluate the clinical efficacy of endoscopic esophageal variceal ligation (EVL) for esophageal variceal bleeding (EVB) in elderly patients with hepatic cirrhosis. Methods From July 2007 to July 2013, clinical data of 198 patients who had been diagnosed with liver cirrhosis presenting with EVB were retrospectively analyzed.Among them, 167 patients who had received EVL were divided into the elderly EVL group (n=97, age≥60 years) and the non-elderly EVL group (n=70, aged<60 years). The other 31 cases (aged≥ 60 years) had received propranolol therapy.Treatment effectiveness, adverse effects, complications and the one-year survival rate of each group were analyzed. Results The efficacy rates and variceal recurrences were 77.3% (75/97) and 78.6% (55/70) in the elderly EVL group and 19.6% (19/97) and 18.6% (13/70) in the non-elderly EVL group, respectively, with no significant difference between the two groups (each P>0.05). The re-bleeding rate was higher in the propranolol treatment group than in the elderly and non-elderly EVL groups 〔58.1%(18/31)vs.24.7%(24/97)vs, 22.9%(16/70), χ2=14.76, P=0.00〕. One-year survival rates in the elderly group, the non-elderly EVL group and the propranolol treatment group were 86.6 (84/97), 88.6% (62/70), 64.5% (20/31), respectively, with statistically significant differences between the three groups (χ2=10.24, P=0.01). Conclusions EVL is effective for the treatment of hepatic cirrhosis with EVB and can be used as a secondary prophylaxis measure for EVB in elderly patients with hepatic cirrhosis. Key words: Endoscopic and gastric variceas; Liver cirrhosis

Association of Endoscopic Esophageal Variceal Ligation With Increased Risk of Duodenal Ulcer

Introduction: This study was to explore the incidence of duodenal ulcer (DU), as well as other clinical characteristics occurring after endoscopic variceal ligation (EVL) of the esophagus. Methods: A total of 47 patients with severe esophageal varices (EVr) who had also undergone EVL and gastroscopic follow-up within 3 months of the procedure was retrospectively analyzed. The status of Helicobacter pylori (Hp) infection, Child-Pugh classification, and the grades of portal hypertensive gastropathy (PHG) were collected. Sixty EVr patients without EVL treatment, but with clinical data available, served as the control group. Results: The incidence of DU in the EVL group (29.8%, 14/47) was higher than that in the control group (6.7%, 4/ 60) (P<0.05). The Hp infection rate in EVL group was 19.15% (9/47), while in control group was 21.67% (13/60) (P>0.05). The Hp positive rate (12.5%, 1/8) in patients exhibited new DUs after EVL was comparable to that in patients without DU in the EVL group (12.1%, 4/33),( P>0.05). Patients with DU after EVL received 14 5.29 of ligating bands, while in those who did not exhibit DUs received 12 6.64 (P<0.05). A logistic regression analysis showed that the occurrence of DU was associated solely with applied band number, and not with age, gender, Child-Pugh classification, or the grade of PHG (P>0.05). Conclusion: Esophageal EVL is associated with a higher risk of DU, which is related to a larger number of applied bands but is not correlated with Hp infection status or other variables.

Effects of propranolol on rebleeding following endoscopic esophageal variceal ligation: a prospective, controlled trial

Effects of propranolol on rebleeding following endoscopic esophageal variceal ligation: a prospective, controlled trial

Prevalence of portal hypertensive colopathy and its relevance to past history of endoscopic esophageal variceal ligation

Prevalence of portal hypertensive colopathy and its relevance to past history of endoscopic esophageal variceal ligation

Cost saving by reloading the multiband ligator in endoscopic esophageal variceal ligation: A proposal for developing countries

To assess the cost savings of reloading the multiband ligator in endoscopic esophageal variceal ligation (EVL) used on the same patient for subsequent sessions. This single centre retrospective descriptive study analysed patients undergoing variceal ligation at a tertiary care centre between 1st January, 2003 and 30th June, 2006. The multiband ligator was reloaded with six hemorrhoidal bands using hemorrhoidal ligator for the second and subsequent sessions. Analysis of cost saving was done for the number of follow-up sessions for the variceal eradication. A total of 261 patients underwent at least one session of endoscopic esophageal variceal ligation between January 2003 and June 2006. Out of 261, 108 patients (males 67) agreed to follow the eradication program and underwent repeated sessions. A total of 304 sessions was performed with 2.81 sessions per patient on average. Thirty-two patients could not complete the program. In 76 patients (70%), variceal obliteration was achieved. The ratio of the costs for the session with reloaded ligator versus a session with a new ligator was 1:2.37. Among the patients who completed esophageal varices eradication, cost saving with reloaded ligator was 58%. EVL using reloaded multiband ligators for the follow-up sessions on patients undergoing variceal eradication is a cost saving procedure. Reloading the ligator thus is recommended especially for developing countries where most of the patients are not health insured.

Effectiveness of manual cleaning and disinfection of gastroendoscopes with 3% glutaraldehyde for decreasing the risk of transmission of hepatitis C virus

OBJECTIVES: The effectiveness of manual cleaning and disinfection of gastroendoscopes with 3% glutaraldehyde in decreasing the risk of transmission of hepatitis C virus (HCV) was examined. METHODS: Gastroendoscopes used for treatment of endoscopic esophageal variceal ligation in patients with HCV infection were manually cleaned and disinfected with 3% glutaraldehyde (n = 25), 2% glutaraldehyde (n = 17), or 0.1% benzethonium chloride (n = 25). Samples were obtained by pouring 20 ml of 0.9% NaCl solution into the biopsy-suction channel of the scope before and after cleaning and disinfection. HCV was detected with the polymerase chain reaction. RESULTS: Of the 25 scopes in 3% glutaraldehyde group, nine (36%) were positive for HCV before cleaning and disinfection, but all became negative after cleaning and disinfection; the difference was statistically significant ( p < 0.01). In contrast, in 2% glutaraldehyde group and in the routine cleaning group, there were no significant differences in the number of positive samples between before and after cleaning and disinfection. CONCLUSION: Manual cleaning and disinfection of gastroscopes with 3% glutaraldehyde is useful for decreasing the risk of transmission of HCV among patients.

7223 Peripheral venous endotoxin levels in patients with esophageal varices during the course of a new form of endoscopic variceal ligation.

Purpose: This study mainly investigated the following: (1) comparison of peripheral venous endotoxin levels in cirrhotic patients with varices before modified endoscopic esophageal variceal ligation (EVL) (“intensive ligation” method: a radical obliterative approach to the treatment of esophageal varices); (2) whether modified EVL affected peripheral venous endotoxin levels in these patients during the course of this therapy. Methods: Twenty patients were treated with modified EVL. The endotoxin level was detected using a new modification of a chromogenic substrate assay (Endospec-SP test) before and after EVL therapy. The normal range of endotoxin was considered 3.0 pg/dl or less. Student's t test was used. The level of significance was p

Efficacy of Endoscopic Esophageal Variceal Ligation in an Immunocompromised Host

Abstract: We successfully treated esophageal varices by endoscopic variceal ligation (EVL) in a 50‐year‐old female patient with common variable immunodeficiency and liver cirrhosis secondary to hepatitis B. Under the existing disadvantageous conditions including the immunocompromised status, hyperal‐lergic reactions to several drugs, chronic pulmonary infection, and impaired hepatic function, we considered EVL to be of greater potential benefit than endoscopic injection sclerotherapy (EIS). This case highlights the possible merits of EVL over EIS, even in the presence of various restrictions, such as the immunocompromised condition of our patient.

A serial transparent endoscopic elastic band ligator

Endoscopic esophageal variceal ligation (EVL) was first introduced by Stiegmann and colleagues1 in 1986,and it has since grown to become an extremely popular modality throughout the world as well as in Japan. The reason for its popularity is primarily the fact that the procedure is minimally operator-dependent and is also associated with fewer local and systemic complications than injection sclerotherapy.2-4