Comparison of Endoscopic Variceal Ligation with Endoscopic Sclerotherapy for Secondary Prophylaxis of Variceal Hemorrhage: A Randomized Trial

et al. 2019

BMC Gastroenterol

Background The recurrence of esophageal varices remains high in patients with hepatic portal hypertension after the endoscopic esophageal variceal eradication therapies, including endoscopic variceal band ligation (EVL), injection sclerotherapy (EIS) or EVL plus EIS. The aim of this study was to evaluate the endoscopic ultrasound probe examinations (EUP) findings in the prediction of recurrence following esophageal variceal eradication in a prospective cohort. Methods A total of 206 cirrhotic portal hypertension patients with esophageal variceal eradication, who underwent endoscopic variceal therapy (EVL or EIS or EVL plus EIS) were initially enrolled. All patients were scheduled for a follow-up every 6 months for up to 3 years. EUP was performed to evaluate peri-esophageal collateral veins (peri-ECVs), perforating veins (PFV) and para-esophageal collateral veins (para-ECVs). In addition, computed tomography (CT) were conducted to detect portal vein diameter, portal vein embolus, and major portosystemic collateral shunts. The relationship between esophageal variceal recurrence and EUP findings were analyzed. Results We found that as high as 93.5% of patients developed esophageal variceal recurrence in the 3-year follow-up. The time of esophageal variceal recurrence after variceal eradication was 13.4 months (13.4 ± 9.2 months). Furthermore, the median time of recurrence in patients who were undertaken EVL,EIS and EVL plus EIS was 10, 13 and 12 months, respectively. We identified that the risk factors, including EVL (OR 0.23, 95% CI 0.08–0.71, p < 0.01), Child-Pugh score (OR 3.32,95% CI 1.31–35.35, p < 0.05), large peri-ECVs (OR 4.56, 95% CI 2.17–9.58, p < 0.0001), and existence of PFV (OR 2.14, 95% CI 1.44–3.16, p < 0.001), were significantly associated with the recurrence of esophageal varices. The peri-ECVs and PFV showed better ability to predict esophageal variceal recurrence. When cut-off value of peri-ECVs diameter was 3.5 mm, the specificity of prediction 1-year variceal recurrence was 86% and the sensitivity was 45%. Conclusions The EUP appears to be very effective, convenient and economical examinations to predict esophageal varices recurrence after variceal eradication by endoscopic therapies. The high Child-pugh score, large peri-ECVs, and PFV are independent risk factors related to esophageal varices recurrence.

Section: Introductionmentioning

confidence: 99%

The endoscopic ultrasound probe findings in prediction of esophageal variceal recurrence after endoscopic variceal eradication therapies in cirrhotic patients: a cohort prospective study

Zheng

et al. 2019

BMC Gastroenterol

“…EIS was superior to EVL in preventing variceal recurrence [4] and is still widely used to control acute esophageal variceal bleeding as well as to eradicate varices to prevent recurrent bleeding. The main reason why EIS is not generally recommended is because of the higher rate of complications and lower effect in reducing mortality [5] .…”

mentioning

confidence: 99%

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

Wang

Zhao

2020

Preprint

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

Transparent cap-assisted endoscopic injection sclerotherapy for the treatment of patients with esophageal varices

Wang¹,

Zhao

2020

Medicine

The aim of this study was to compare the efficacy and safety of cap-assisted endoscopic injection sclerotherapy (EIS) versus direct EIS in the management of esophageal variceal bleeding in patients with cirrhosis. This retrospective study included patients with cirrhosis and esophageal variceal bleeding who underwent EIS with or without the use of a transparent cap at Shandong Provincial Hospital between December 2014 and April 2017. Patients were divided into two groups: Group A (EIS with transparent cap, n = 50) and Group B (direct EIS, n = 45). Data collected included patients’ demographics, procedure details, and rates of variceal eradication, variceal rebleeding, variceal recurrence, and survival during the follow-up period. All data were expressed as mean ± SD. Quantitative variables were compared with Student t test; qualitative variables were compared with the Fisher exact test or chi-square test. P values less than .05 were considered significant. The mean follow-up duration was similar in both groups (16.3 ± 10.2 mo in Group A and 15.5 ± 9.5 mo in Group B). The volume of sclerosant (64.86 ± 10.62 vs 104.73 ± 21.25 ml, P = .044), mean number of sessions (2.37 ± 1.15 vs 5.70 ± 1.57, P = .042), time required to perform endoscopic treatment (6.57 ± 1.50 vs 11.22 ± 2.29 minutes, P = .049), and time to initial esophageal varices eradication (5.43 ± 1.38 vs 8.93 ± 1.5 wk, P = .041) were significantly smaller in the cap-assisted EIS group than in the direct EIS group. The probability of variceal recurrence and rebleeding was significantly higher in the direct EIS group than in the cap-assisted EIS group (14% versus 35.6% and 20% versus 40%). Only 22 patients (44%) developed complications in the cap-assisted group versus 30 patients (66.7%) in the EIS group (P = .039). The probability of survival was similar in both groups (86% versus 75.6%, P = .133). Modified EIS with the use of a transparent cap resulted in lower rates of esophageal variceal recurrence, rebleeding, and complications, compared with direct EIS.