Is there a role for combined sclerotherapy and ligation in the endoscopic treatment of gastroesophageal varices?

Laine, Loren

doi:10.1016/j.gie.2017.02.005

Cited by 6 publications

(11 citation statements)

References 13 publications

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“…Prior to PSM, our study showed that patients treated with EVL plus EIS had significantly less varicose recurrence and rebleeding than patients treated with EVL alone, whether at 6-, 12-, or 18-month follow-up. Our results agree with Mansour et al and Wang et al (2,10,14,15). Compared with EVL alone, the EVL plus EIS group had a significant advantage in variceal recurrence and rebleeding for the following principal reasons.…”

Section: Discussionsupporting

confidence: 92%

“…The advantages of our procedure are as follows: (1) the transparent cap is still present at the tip of the lens after EVL, which can fix the varicose vein and facilitate sclerotherapy and can also be used for compression if there is leakage; (2) performing EVL followed by EIS can also reduce the risk of bleeding after ligation of the thick varicose vein; (3) performing EVL earlier can reduce the pressure in the varicose vein and create conditions for subsequent sclerotherapy (less sclerosing agent, long sclerosing agent dwell time); and (4) the procedure does not require special skills and equipment. But, at present, there are still controversies about the efficacy and adverse events of EVL plus EIS and EVL alone for esophageal varicose (2,10,14,15). A meta-analysis discovered that EVL is superior to the combination of EVL and EIS in safety, while no significant differences were found in efficacy (2).…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis discovered that EVL is superior to the combination of EVL and EIS in safety, while no significant differences were found in efficacy (2). However, some studies support that the combination of EVL and EIS is better than EVL alone (10,14,15). For example, Jianbo Wang et al retrospectively analyzed the rebleeding rate and variceal recurrence at 6 months in 84 patients, of which 40 patients were treated with EVL alone and 44 patients were treated with EVL plus EIS and indicated that EVL plus EIS showed less rebleeding rates and variceal recurrence at 6 months and less chest pain and was more cost-effective compared to EVL alone in the treatment of gastroesophageal varices.…”

Section: Discussionmentioning

confidence: 99%

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Esophageal variceal ligation plus sclerotherapy vs. ligation alone for the treatment of esophageal varices

Yue

Wang

et al. 2022

Front. Surg.

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BackgroundThis study aimed to evaluate the efficacy and adverse events of esophageal variceal ligation (EVL) vs. EVL combined with endoscopic injection sclerosis (EIS) in the therapy of esophageal varices.MethodsPatients from January 2017 to August 2021 who received EVL alone (control group) or EVL plus EIS (intervention group) were enrolled in this retrospective study. Efficacy, including rebleeding (clinically hematemesis or melena, confirmed by endoscopy as esophagogastric varices bleeding), variceal recurrence rate (the presence of esophagogastric varices which is needed to be treated again) the number of sessions performed to complete eradication of varices, and safety (adverse events) were compared. The variceal recurrence-associated factors were derived by univariate and multivariate logistic regression analyses.ResultsThe variceal recurrence and rebleeding rate in the intervention group showed significantly lower than the control group (2.6% vs 10.3%, P = 0.006 and 20.7% vs 37.5%, P = 0.029, P = 0.006, respectively, in the 12-month follow-up). The adverse events (fever, chest pain, swallowing, and esophageal stricture) showed no significant difference between the two groups (P > 0.05). Further research showed that the efficacy of the intervention group was better than the control group only achieved in prophylactically endoscopic treatment patients. The diameter of esophageal varices and gastric varices co-exist showed significant effects on variceal recurrence in intervention group [odds ratio (OR) = 15.856; 95% confidence interval (CI), 1.709–160.143; P = 0.016 and OR = 4.5; 95% CI, 1.42–20.028; P = 0.021; respectively].ConclusionsThe intervention group may obtain lower recurrence, rebleeding rate, and fewer sessions performed to complete eradication of varices (number of sessions) and similar incidence of adverse events, especially for prophylactically treatment. Among the intervention group, the diameter of esophageal varices and gastric varices were closely associated with variceal recurrence.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Esophageal variceal ligation plus sclerotherapy vs. ligation alone for the treatment of esophageal varices

Yue

Wang

et al. 2022

Front. Surg.

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“…For IGV, the data are even more limited but in a meta‐analysis of available data from two randomised trials ( N = 24) 82,83 more rebleeding occurred with ligation than with butyl‐cyanoacrylate in IGV (OR: 15.98; 95% CI: 1.71–149.12) 69 …”

Section: Endoscopic Managementmentioning

confidence: 99%

Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management

Shung,

Laine

2024

Aliment Pharmacol Ther

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SummaryBackgroundAcute upper gastrointestinal bleeding (UGIB) is a common emergency requiring hospital‐based care. Advances in care across pre‐endoscopic, endoscopic and post‐endoscopic phases have led to improvements in clinical outcomes.AimsTo provide a detailed, evidence‐based update on major aspects of care across pre‐endoscopic, endoscopic and post‐endoscopic phases.MethodsWe performed a structured bibliographic database search for each topic. If a recent high‐quality meta‐analysis was not available, we performed a meta‐analysis with random effects methods and odds ratios with 95% confidence intervals.ResultsPre‐endoscopic management of UGIB includes risk stratification, a restrictive red blood cell transfusion policy unless the patient has cardiovascular disease, and pharmacologic therapy with erythromycin and a proton pump inhibitor. Patients with cirrhosis should be treated with prophylactic antibiotics and vasoactive medications. Tranexamic acid should not be used. Endoscopic management of UGIB depends on the aetiology. For peptic ulcer disease (PUD) with high‐risk stigmata, endoscopic therapy, including over‐the‐scope clips (OTSCs) and TC‐325 powder spray, should be performed. For variceal bleeding, treatment should be customised by severity and anatomic location. Post‐endoscopic management includes early enteral feeding for all UGIB patients. For high‐risk PUD, PPI should be continued for 72 h, and rebleeding should initially be evaluated with a repeat endoscopy. For variceal bleeding, high‐risk patients or those with further bleeding, a transjugular intrahepatic portosystemic shunt can be considered.ConclusionsManagement of acute UGIB should include treatment plans for pre‐endoscopic, endoscopic and post‐endoscopic phases of care, and customise treatment decisions based on aetiology and severity of bleeding.

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“…EVS was the first endoscopic treatment to be shown to be superior to balloon tamponade (BT) or vasoactive drugs in the past [ 75 ]. Although EVS was used for endoscopic therapy in the 1980s, it was largely replaced by EBL in the 1990s after studies revealed fewer re-bleeding episodes and adverse events [ 76 ].…”

Section: Prevention and Management Of Variceal Bleedingmentioning

confidence: 99%

Diagnosis and Management of Esophagogastric Varices

et al. 2023

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Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and is one of the most common causes of acute upper gastrointestinal bleeding. Thus, esophagogastric varices represent a major economic and population health issue. Patients with advanced chronic liver disease typically undergo an upper endoscopy to screen for esophagogastric varices. However, upper endoscopy is not recommended for patients with liver stiffness < 20 KPa and platelet count > 150 × 109/L as there is a low probability of high-risk varices. Patients with high-risk varices should receive primary prophylaxis with either nonselective beta-blockers or endoscopic band ligation. In cases of AVB, patients should receive upper endoscopy within 12 h after resuscitation and hemodynamic stability, whereas endoscopy should be performed as soon as possible if patients are unstable. In cases of suspected variceal bleeding, starting vasoactive therapy as soon as possible in combination with endoscopic treatment is recommended. On the other hand, in cases of uncontrolled bleeding, balloon tamponade or self-expandable metal stents can be used as a bridge to more definitive therapy such as transjugular intrahepatic portosystemic shunt. This article aims to offer a comprehensive review of recommendations from international guidelines as well as recent updates on the management of esophagogastric varices.

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Is there a role for combined sclerotherapy and ligation in the endoscopic treatment of gastroesophageal varices?

Cited by 6 publications

References 13 publications

Esophageal variceal ligation plus sclerotherapy vs. ligation alone for the treatment of esophageal varices

Esophageal variceal ligation plus sclerotherapy vs. ligation alone for the treatment of esophageal varices

Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management

Diagnosis and Management of Esophagogastric Varices

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