IntroductionEndoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of oesophageal variceal bleeding in cirrhosis in a located population in Morocco.MethodsVia a retrospective study over 118 months (December 2001- October 2011), cirrhotic patients with endoscopically proven esophageal variceal hemorrhage were treated by endoscopic variceal ligation. We studied the rate of haemostasis, rebleeding, complications and mortality.Results360 cirrhotic patients were included and 378 haemostatic variceal ligations were performed. Primary haemostasis was obtained in 96.5 % (N=365) of cases. Thirty three patients (8.7%) bled during follow-up. The rate of minor complications was 15.3 % (N=58). Retrosternal pain, fever, dysphagia and Overtube's migration developed in 8.4 % (N=32); 2.6 % (N=10); 3,7 % (N=14) and 0.5 % (N=2) of the patients respectively. Severity of these complications was mild and transient. The rate of oesophageal ulcers was 5 % (N=19), while the mortality rate by haemorrhage was 5 % (N=18).ConclusionOur data showed that band ligation is an effective and safe treatment modality of esophageal variceal bleeding with low rates of rebleeding and complications.

Objectif : L'hémorragie digestive haute (HDH) est une urgence fréquente en hépatogastroentérologie. Le profil épidémiologique des HDH reste mal connu dans notre pays. Le but de notre travail est de décrire le profil épidémio-logique, étiologique et évolutif des HDH et d'analyser les différents facteurs liés à la mortalité. Matériels et méthodes : Il s'agit d'une étude initialement rétrospective [2001][2002][2003][2004] puis prospective [2005][2006][2007][2008], ayant inclus tous les patients adultes qui se sont présentés pour une HDH et ayant bénéficié d'une endoscopie haute au centre hospitalier universitaire Hassan-II de Fès. Résultats : Mille trois cent trois cas ont été inclus. Huit cent vingt-sept étaient des hommes représentant 63,5 % des patients. L'âge moyen des patients était de 47,6 ± 17,7 ans. Les étiologies les plus fréquentes étaient l'hémorragie ulcéreuse (46 %) et l'hémorragie liée à l'HTP (23,3 %). La prévalence des oesophagites était de 10,9 % et celle des gastrites aiguës de 7,3 %. Les taux de récidive précoce et de mortalité intrahospitalière étaient de 8,3 et 6,5 % respectivement. Les hémorragies liées à l'HTP ou à la pathologie tumorale, l'âge avancé, l'état de choc initial et la récidive hémorragique sont les principaux facteurs de risque de mortalité retrouvés dans notre étude.Conclusion : Les patients de notre série avaient un âge jeune. La première étiologie des HDH dans notre contexte était la pathologie ulcéreuse reflétant la prévalence de celle-ci dans notre population. Les hémorragies liées à l'hypertension portale, l'âge avancé et la récidive hémorragique étaient les principaux facteurs liés à la mortalité. Pour citer cette revue : Acta Endosc. 41 (2011). Mots clésHémorragie digestive haute · Épidémiologie · Mortalité · Endoscopie · Ulcère gastroduodénal · Hypertension portale Abstract Background: Acute upper gastrointestinal bleeding (AUGIB) is a common emergency in hepatogastroenterology. Epidemiology of AUGIB in our country remains unknown. The aim of this study is to evaluate the clinical and etiological characteristics and outcomes of patients with upper gastrointestinal bleeding and to define risk factors of poor prognosis. Materials and methods: This is a retrospective (2001)(2002)(2003)(2004) and prospective (2005)(2006)(2007)(2008) study, including patients with AUGIB who had upper digestive endoscopy in Hassan II University Hospital of Fez. Results: Thousand three hundred and three cases were included. Eight hundred and twenty-seven were men (63.5%). The mean age was 47.6 ± 17.7 years. The most common causes of AUGIB were ulcer bleeding (46%) and bleeding related to portal hypertension (PH) (23.3%). Prevalence of esophagitis and acute gastritis were 10.9% and 7.3% respectively. The recurrence rate and in-hospital mortality were 8.3% and 6.5% respectively. Portal hypertension-related bleeding, malignancy, advanced age, shock and recurrent bleeding were the main risk factors of mortality in our study. bleeding, which reflects the prevalence of peptic ulcer in our population. ...

IntroductionLong-term outcome of patients after band ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation in patients with portal hypertension in the Hassan II university hospital, Fes, Morocco.MethodsOver 118 months patients treated by endoscopic variceal ligation were received regular follow- up and detailed clinical assessment of at least 24 months.ResultsOne hundred twenty five patients were followed up for a mean of 31 months (range 12-107 months). Obliteration of the varices was achieved in 89.6 % (N = 112) of patients, with 3 +/-1.99 (range 1-8) endoscopy sessions over a period of 14 + /-6.8 weeks (range 3-28). The percentage of variceal recurrence during follow-up after ligation was 20.5 % (N = 23). Recurrence were observed in a mean of 22 months +/- 7.3 (range 3-48). Bleeding rate from recurrent varices was 30.4 % (7/23). Rebleeding from esophageal ulcers occurred in 5.6 % (7/125) of patients. Portal hypertensive gastropathy before and after eradication of varices was 17.6% (N = 22) and 44.6% (N = 50) respectively; p< 0.05. Fundal gastric varices was 30.4% (N = 38) and 35.7% (N = 40) before and after eradication of varices respectively; p> 0.05. The overall mortality was 4 % (N = 5).ConclusionBand ligation was an effective technical approach for variceal obliteration with low rates of variceal recurrence, rebleeding and development of gastric varices. Furthermore, it was associated with frequent development of portal hypertensive gastropathy.

No abstract

No abstract