A transparent cap assisted endoscopic injection sclerotherapy for the treatment of patients with esophageal varices

Abstract

Aim: The aim of this study was to compare the efficacy and safety of cap assisted endoscopic injection sclerotherapy(EIS) versus direct endoscopic injection sclerotherapy(EIS) in the management of patients with cirrhosis after esophageal variceal bleeding .Methods: Patients with cirrhosis suffering from esophageal variceal bleeding who underwent EIS with or without the help of a transparent cap in Shandong Provincial Hospital between Novermber December 2014 and April 2017 were included in this retrospective study. All of the cases included in the study were divided into two groups: Group A (EIS with a transparent cap, n=50), Group B (direct EIS, n=45). Data collected included patients' demographics, details of the procedure, variceal eradication, variceal rebleeding, variceal recurrence and survival during the follow-up period. All data were expressed as mean ± SD. Quantitative variables were compared by Student t test, and qualitative variables were compared by the Fisher exact test or the chi-square test. A P value less than 0.05 was considered significant.Results: The mean duration of follow-up was similar in both groups(16.3±10.2 mo and 15.5±9.5 mo, respectively). To achieve the eradication of varices, the volume of sclerosant (64.86±10.62 ml vs 104.73±21.25 ml, P =0.044), the mean number of sessions (2.37±1.15 times vs 5.70±1.57 times, p =0.042), the time required to perform endoscopic treatment(6.57±1.50 minutes vs 11.22±2.29 minutes, P =0.049) and the time for the initial esophageal varices eradication were significantly reduced in the cap assisted EIS group than in the direct EIS group(5.43±1.38 weeks vs 8.93±1.5 weeks, P =0.041). The probability of variceal recurrence and rebleeding was significantly higher in the direct EIS group than in cap assisted EIS group. Only 22 patients (44%) developed complications in the cap assisted EIS group as compared to 30 patients ( P =0.039) in the EIS group. The probability of survival was similar in both groups ( P =0.133).Conclusion: EIS with a transparent cap is an effective and safe treatment for esophageal varices. BackgroundEsophageal variceal bleeding is a major cause of morbidity in patients with cirrhosis. Endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy(EIS) were widely used to treat