Currently, endoscopic injection sclerotherapy(EIS) is the most widely used method for treating and eradicating acutely bleeding esophageal varices in repeated sessions, but may be associated with some undesirable local and systemic complications.
Endoscopic variceal ligation (EVL), a newly developed method to manage esophageal variceal bleeding alternating EIS, induces mechanical ligation and strangulation of varices by using elastic "O" rings.
This study assessed initial control rate of active variceal bleeding, incidence of rebleeding, changes in grade of varices, survival rate, and complications associated with EVL.
Over a 15 months period, EVL was performed on 30 consecutive patients who had visited Taegu Catholic University Hospital by recent esophageal variceal bleeding or by actively bleeding varices. Total of 316 varix ligations were performed during 85
separated EVL sessions. Active breeding varices were initially controlled in all seven(100%) patients. There were a 30% incidence of recurrent bleeding. By a mean of 3.4 times of EVL sessions, variceal eradication or reduction of size of grade I
was
achieved in thirteen patients. No major complications (perforation, stricture, deep ulceration) were noted and there were no treatment failures or exacerbations. Seven(23%) patients died, two from hepatic failure, one from rebleeding with refusal
for
repeated ligation, one from hepatic coma, two from hepatorenal syndrome, one from other cause (pancreatic cancer).
These results suggest that EVL can be used effectively to control active variceal bleeding, prevent rebleeding and eradicate varices with repeated ligations. We conclude that EVL is a safe effective alternative treatment to sclerotherapy for
esophageal
varices.
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