Comparison between endoscopic sclerotherapy and band ligation for hemostasis of acute variceal bleeding

Abstract

AIM:To compare band ligation (BL) with endoscopic sclerotherapy (SCL) in patients admitted to an emergency unit for esophageal variceal rupture. METHODS:A prospective, randomized, single-center study without crossover was conducted. After endoscopic diagnosis of esophageal variceal rupture, patients were randomized into groups for SCL or BL treatment. Sclerotherapy was performed by ethanolamine oleate intravascular injection both above and below the rupture point, with a maximum volume of 20 mL. For BL patients, banding at the rupture point was attempted, followed by ligation of all variceal tissue of the distal esophagus. Primary outcomes for both groups were initial failure of bleeding control (5 d), early re-bleeding (5 d to 6 wk), and complications, including mortality. From May 2005 to May 2007, 100 patients with variceal bleeding were enrolled in the study: 50 SCL and 50 BL patients. No differences between groups were observed across gender, age, ChildPugh status, presence of shock at admission, mean hemoglobin levels, and variceal size. RESULTS:No differences were found between groups for bleeding control, early re-bleeding rates, complications, or mortality. After 6 wk, 36 (80%) SCL and 33 (77 %) EBL patients were alive and free of bleeding. A statistically significant association between Child-Pugh status and mortality was found, with 16% mortality in Child A and B patients and 84% mortality in Child C patients (P <0.001). CONCLUSION:Despite the limited number of patients included, our results suggest that SCL and BL are equally efficient for the control of acute variceal bleeding.

Variceal recurrence, rebleeding rates and alterations in clinical and laboratory parameters following post‐variceal obliteration using endoscopic sclerotherapy

“…Variations in the technique or the sclerosant used have not been shown to influence the outcome of bleeding rates . In a recent study Luz et al . found that EST and EVL were equally efficient for the control of acute variceal bleeding and there were no differences in early rebleeding rates, complications or mortality.…”

Clinical management of advanced schistosomiasis: a case of portal vein thrombosis-induced splenomegaly requiring surgery

“…Bleeding from oesophageal or gastric varices typically results in a high death rate. For bleeding oesophageal or gastric varices, endoscopy-guided injection sclerotherapy or band ligation of the bleeding varices are the most appropriate immediate treatment procedures 24. However, the facilities and expertise for these procedures are not always available in many developing countries where schistosomiasis is endemic.…”

Results of treatment of esophageal variceal hemorrhage with endoscopic injection of n-butyl-2-cyanoacrylate in patients with Child-Pugh class C cirrhosis

“…In the current study, our question was whether the results obtained in the RCT conducted by members of our group and their colleagues 8 would be reproducible outside the artificial environment created by RCTs. Thus, our objective was to investigate the following 3 outcomes in patients with Child-Pugh class C cirrhosis who underwent endoscopic injection of n-butyl-2-cyanoacrylate to treat esophageal variceal hemorrhage: (1) rate of failure to control bleeding (up to 5 days after the index bleeding), (2) rate of failure of secondary prophylaxis (from 6 days until 6 weeks after the index bleeding), and (3) complication and mortality rates.…”

“…Patients with Child-Pugh class C cirrhosis, or those with class B cirrhosis with active bleeding at the index endoscopy, are at high risk for treatment failure and have a poor prognosis 5 6 7 8 9 . In a previous randomized controlled trial (RCT), conducted by several investigators among our group (S. E. M., S. C., P. S., and F. M.-F.) and their colleagues 8 , 88 patients with esophageal variceal bleeding were treated with sclerotherapy or elastic band ligation (EBL). Patients with Child-Pugh class C cirrhosis had a 6-week mortality rate of 45.7 %, whereas no deaths occurred in the group of patients with Child-Pugh class A cirrhosis ( P < 0.001).…”