Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

Abstract

acute variceal bleeding proved to be superior to vasoconstricActive bleeding varices are a great challenge to endostors or balloon tamponade in the control of hemorrhages. [5][6][7] copists. In this study, we compared the short-term effiNevertheless, substantial complications may be associated cacy and safety of banding ligation with injection sclerowith EIS. 8 Furthermore, while EIS has been used extentherapy in the arresting of active bleeding from sively, it also has not had a significant impact on survival.4 esophageal varices. Seventy-one cirrhotic patients with Endoscopic variceal ligation (EVL) has been adopted in recent active variceal bleeding were randomized to receive years to substitute for EIS in managing bleeding esophageal banding ligation (37 patients) or sclerotherapy (34 pavarices.9 tients) immediately after endoscopic examinations. PriMost controlled studies comparing EVL with EIS favored mary success rate (bleeding stopped for 72 hours) was EVL in terms of sessions required to achieve variceal oblitera-97% in the ligation group and 76% in the sclerotherapy tion, rebleeding rate, and complication rate. [10][11][12][13] On the other group (P Å .009). The efficacy of ligation was similar to hand, EIS and EVL were found to be of similar effectiveness sclerotherapy in the control of oozing varices (100% vs.in terms of arresting active bleeding. 14 However, all of those 89%, P Å .23), whereas ligation was superior to sclerostudies comprised only a small number of patients with active therapy in the control of spurting varices (94% vs. 62%, variceal bleeding. Thus, a larger study comparing EVL with P Å .012). The requirement of vasoconstrictors after EIS for the control of active variceal bleeding is mandatory. emergency endoscopic treatment was lower in the ligaThis study was undertaken to investigate the efficacy and tion group than in the sclerotherapy group (11% vs. 41%, safety of EIS and EVL in the control of active bleeding from P Å .007). Treatment failure within 1 month was 8% in esophageal varices. the ligation group vs. 30% in the sclerotherapy group (P Å .02). Blood transfusion requirements were signifi-PATIENTS AND METHODS cantly lower in the ligation group than in the sclerotherapy group (3.2 { 1.2 vs. 4.5 { 1.8 units, P õ .01). RebleedBetween October 1991 and June 1995, seventy-one consecutive ing rate within 1 month was 17% in the ligation group cirrhotic patients with active variceal bleeding admitted to Veterans and 33% in the sclerotherapy group (P Å .19). Significant General Hospital-Kaohsiung (Taiwan, Republic of China) were enrolled in the study. All of the patients were proven to be actively complications were encountered in 5% of the ligation bleeding from esophageal varices by emergency endoscopy within 12 group and 29% of the sclerotherapy group (P Å .007).hours of admission. Among them, emergency endoscopy was perMortality rates within 1 month were 19% in the ligation formed in forty-two patients within 6 hours of entry to the emergency group and 35% in the sclerotherapy gr...

Improved survival after variceal bleeding in patients with cirrhosis over the past two decades

“…[12][13][14] Although band ligation may sometimes be difficult in active variceal bleeding, it was associated with a greater efficacy in controlling bleeding and a lower number of complications than sclerotherapy. 15,16 Pharmacological therapy has also concurrently evolved considerably. The use of vasopressin was limited because it may cause severe vascular complications.…”

Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding: A prospective randomized trial

“…Second, it has been demonstrated in a recent study that emergency banding ligation is at least as effective as EST, while it is associated with a significantly lower complications rate even in the treatment of active variceal bleeding. 30 This suggests that emergency banding ligation may be more adequate than EST in this setting. Finally, it has also been suggested that monitoring of hepatic venous pressure gradient during the acute esophageal variceal bleeding episode can identify patients with a high risk of continued bleeding or early rebleeding.…”

The use of esophageal stent in controlling acute refractory variceal bleeding

“…This incidence was higher than in previous reports on the treatment for high-risk variceal bleeding. (3,4) Apart from 10 patients who received TIPS, it appeared that another 5 patients did not receive definitive therapy after removal of balloon tamponade. Fourthly, 1 patient allocated to the esophageal stent group failed to be deployed and then received balloon tamponade.…”

“…As he correctly points out, (1,2) a decision for an early, preemptive PTFE-covered TIPS should be considered in high-risk patients bleeding from varices, as was the case in 16 of the 28 patients included in our study. (3) Not all of these patients were treated in hospitals with the necessary facilities and expertise for placing early TIPS, which is the major limitation of this strategy. Furthermore, the definition of a high-risk patient qualifying for early TIPS may require further refinement.…”