Randomized controlled trial of scleroligation versus band ligation alone for eradication of gastroesophageal varices

Mansour, Loai; El-Kalla, Ferial; El-Bassat, Hanan; Abd-Elsalam, Sherief; El-Bedewy, Mohamed; Kobtan, Abdelrahman; Badawi, Rehab; Elhendawy, Mohammed

doi:10.1016/j.gie.2016.12.026

Cited by 46 publications

(42 citation statements)

References 20 publications

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“…The results showed no significant differences between treatment groups in initial control of active bleeding, rebleeding, mortality, adverse events, or cost. 2 Pain was somewhat more common in the combined group (13% vs 3%, P Z .04), but the mean number of sessions to achieve variceal eradication was lower with combined therapy (2.2 vs 3.4). 2 By contrast, none of the many previous randomized trials in esophageal variceal bleeding found a significantly lower number of sessions to achieve eradication with combined therapy versus ligation alone.…”

Section: Combination Endoscopic Therapy For Bleeding Govmentioning

confidence: 89%

“…2 Pain was somewhat more common in the combined group (13% vs 3%, P Z .04), but the mean number of sessions to achieve variceal eradication was lower with combined therapy (2.2 vs 3.4). 2 By contrast, none of the many previous randomized trials in esophageal variceal bleeding found a significantly lower number of sessions to achieve eradication with combined therapy versus ligation alone. 12 Mansour et al 2 suggested that injecting sclerosant distal to the ligation site increased sclerosant contact time, resulting in improved eradication.…”

Section: Combination Endoscopic Therapy For Bleeding Govmentioning

confidence: 89%

“…Studies of gastric variceal bleeding typically include patients whose bleeding is thought to originate distally to the gastroesophageal junction. However, Mansour et al 2 included only patients whose bleeding site was proximal to the gastroesophageal junction. Therefore, classification of this trial is somewhat difficult.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Laine

2017

Gastrointestinal Endoscopy

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Section: Combination Endoscopic Therapy For Bleeding Govmentioning

confidence: 89%

Section: Combination Endoscopic Therapy For Bleeding Govmentioning

confidence: 89%

See 1 more Smart Citation

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

Laine

2017

Gastrointestinal Endoscopy

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“…Patients with oesophageal varices have a high tendency to develop bleeding. Only 10-20% of variceal bleeding occurs from gastric varices, but the associated outcome is worse than that of bleeding from oesophageal varices (2)(3)(4)(5). Patients surviving a variceal bleed are at high risk of rebleeding (>60% in the first year) and the mortality of each rebleeding episode is ~20% (6).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis

Kong

Shi

2020

Exp Ther Med

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The purpose of the present study was to compare the effectiveness of the transjugular intrahepatic portosystemic shunt (TIPS), endoscopic options, medications and mainstay combination therapies for patients with cirrhosis who have had at least one episode of variceal haemorrhage. The PubMed, Embase, Cochrane Library and Web of Science databases, as well as the reference lists of relevant articles, were searched to identify eligible studies. P-scores, that were based solely on the point estimates and standard errors of the network estimates, were performed to rank all treatments, on a scale from 0 (worst) to 1 (best). The odds ratio (OR) was determined to assess effects on mortality, treatment failure and bleeding from gastroesophageal ulcers. A total of 43 randomized controlled trials comprising 3,787 adult patients were included. In total, 26 (61%) trials adopted concealed randomization, while most studies did not specify blinding. The drug combination of nadolol and isosorbide mononitrate (ISMN) ranked first for lowering risks of overall mortality (P-score=0.8162), mortality due to liver failure (P-score=0.7536) and bleeding from gastroesophageal ulcers (P-score=0.7536). This combination was determined to be superior to endoscopic sclerotherapy (ES) alone (OR=0.63, 95% CI: 0.42-0.94) and TIPS alone in reducing overall mortality (OR=0.62, 95% CI: 0.40-0.96). ES was more likely to increase treatment failure compared with TIPS, endoscopic variceal liga-tion (EVL), ES plus EVL, EVL plus nadolol/propranolol plus ISMN and nadolol/propranolol plus ISMN. In conclusion, the present network meta-analysis suggested that for a decreased mortality due to variceal rebleeding in patients with cirrhosis, nadolol plus ISMN may be a preferable choice, while ES is associated with a higher risk of unfavourable treatment outcomes. Further well-controlled studies are required to further elucidate the appropriate treatment options.

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“…These studies on the prognosis of rebleeding in GOV patients is mostly concentrated on IGV1, however, the study in GOV2 is limited (3). At present, endoscopic treatment, including endoscopic variceal sclerotherapy (EVS), endoscopic band ligation (EBL), endoscopic variceal obturation (EVO), and combined therapy (9), is optimal for preventing the rebleeding of GOVs. GOV2 is a type that more prone to bleeding, but studies about the treatment effect and prognosis of rebleeding in GOV2 patients after endoscopic secondary prophylaxis treatment is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Predictors of endoscopic prophylaxis for rebleeding in esophageal varices combined type 2 gastroesophageal varices

Jiang

Nie

Zhang

et al. 2020

Preprint

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Background: Patients with decompensated cirrhosis and esophageal varices (EVs) combined with type 2 gastroesophageal varices (GOV2) are at risk of rebleeding after endoscopic prophylaxis. This study was performed to evaluate the preventive efficacy of endoscopic treatment in patients with EVs combined with GOV2, and to identify the risk factor of rebleeding. Methods: We performed a single-center, observational, retrospective study of hospitalized patients with EVs combined with GOV2. The biochemical examination results, demographics, endoscopic performance measures and treatment methods of patients undergoing endoscopic treatment were collected. All patients were observed for 1-year, or were loss to follow-up. The predictors of rebleeding were analyzed by logistic regression analysis.Results: A total of 124 patients underwent endoscopic treatment, including 2 (1.6%) patients in whom bleeding failed to cease and 19 (15.3%) patients who were lost to follow-up. A total of 103 patients were observed until 1 year, including 11 (10.7%) patients who experienced rebleeding. The results indicated that EVs+GOV2 with GOV1, age, prothrombin time (PT), bilirubin level, platelet count, Child-Pugh grade, and model for end-stage liver disease (MELD) score were associated with rebleeding at 1 year in patients with EVs combined with GOV2. Multivariate logistic analysis revealed that age, EVs+GOV2 with GOV1, bilirubin level, and PT were independent risk factors for rebleeding.Conclusion: Endoscopic treatment is effective as a preventive treatment in patients with EVs combined with GOV2. EVs combined with GOV1, older age, coagulation failure, and increased bilirubin levels should be given close attention due to their associations with rebleeding after endoscopic prophylaxis. GOV1 may have a negative effect in patients with EVs +GOV2.

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Randomized controlled trial of scleroligation versus band ligation alone for eradication of gastroesophageal varices

Cited by 46 publications

References 20 publications

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

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

Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis

Predictors of endoscopic prophylaxis for rebleeding in esophageal varices combined type 2 gastroesophageal varices

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