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

Abstract

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.

Cap-Assisted Endoscopic Sclerotherapy vs Ligation in the Long-Term Management of Medium Esophageal Varices: A Randomized Trial

“…Another recent retrospective study compared the efficacy and safety of CAES vs direct EIS in the long-term management of EVs graded as F2 or F3 in patients with cirrhosis. Although these patients developed complications with a high incidence (44%–66.7%), which may be due to the large volume of sclerosant (<40 mL of lauromacrogol) per session, CAES resulted in lower rates of EV recurrence and rebleeding than those after conventional EIS ( 16 ).…”

Efficient Initial Eradication of Large Esophageal Varices by Balloon-compression Endoscopic Injection Sclerotherapy

“…EVL shows a higher frequency of variceal recurrence owing to the residual small varices and patency of interconnecting and feeding vessels in the deeper esophageal wall layers 15. EIS is superior to EVL in its feasibility of treating large EVs and preventing variceal recurrence 16. However, conventional EIS is associated with a higher risk of ectopic embolism, particularly in patients with large EVs, as the sclerosant may flow beyond the injection site through large varices and then return to the azygos vein and eventually to the superior vena cava 17…”

“…15 EIS is superior to EVL in its feasibility of treating large EVs and preventing variceal recurrence. 16 However, conventional EIS is associated with a higher risk of ectopic embolism, particularly in patients with large EVs, as the sclerosant may flow beyond the injection site through large varices and then return to the azygos vein and eventually to the superior vena cava. 17 Our previous case report demonstrated that bc-EIS is successful in the treatment of EVs.…”