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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...

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The results confirm that the beneficial effects of albumin are related to the reduction of the levels of TNF-alpha and NOx in both plasma and ascitic fluid. The infusion of albumin continuously for 3 days in addition to antibiotic treatment at the time of SBP detection is recommended as an effective therapy for patients with cirrhosis and SBP.

Both medical therapy and endoscopic variceal ligation (EVL) have proven to be comparable in the prevention of variceal rebleeding. However, the long-term results are still lacking. Our previous study enrolled 121 patients with history of esophageal variceal bleeding and randomized to receive EVL (EVL group, 60 patients) or drug therapy, nadolol plus isosorbide-5-mononitrate (N؉I) (N؉I group, 61 patients) to prevent variceal rebleeding. The EVL group received ligation regularly until variceal obliteration. The N؉I group received N؉I during the study period. A fter initial control of acute variceal bleeding, patients have up to a 70% risk of rebleeding and a mortality of 20%-35%. 1,2 The importance of preventing rebleeding in patients surviving an episode of acute variceal hemorrhage is well recognized and a lot of studies have been performed. [2][3][4] In the recent decade, endoscopic variceal ligation (EVL) has been shown to be safer and more effective than endoscopic injection sclerotherapy (EIS) and becomes the endoscopic treatment of choice in the management of bleeding esophageal varices. [5][6] On the other hand, the addition of isosorbide-5-mononitrate (ISMN) to propranolol enhanced the reduction of portal pressure and effectiveness in the prevention of variceal rebleeding. [7][8] Up to now, four controlled studies have compared the effectiveness of EVL with a combination of beta-blocker and ISMN but with divergent results. 9-12 Previous reports generally observed for only a mean of 1 to 2 years. Thus, we extended our study to compare the long-term effectiveness and survival of EVL with nadolol and ISMN (NϩI) in the prevention of rebleeding from esophageal varices.

BackgroundLethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation.MethodsWe retrospectively evaluated the safety and efficacy of using large balloon dilation alone without the use of sphincterotomy for the treatment of large common bile duct stones in Kaohsiung Veterans General Hospital. Success rate of stone clearance, procedure-related adverse events and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.ResultsA total of 247 patients were reviewed in the current study. The mean age of the patients was 71.2 years. Most of them had comorbidities. Mean stone size was 16.4 mm. Among the patients, 132 (53.4%) had an intact gallbladder and 121 (49%) had a juxtapapillary diverticulum. The mean size of dilating balloon used was 13.2 mm. The mean duration of the dilating procedure was 4.7 min. There were 39 (15.8%) patients required the help of mechanical lithotripsy while retrieving the stones. The final success rate of complete retrieval of stones was 92.7%. The rate of pancreatic duct enhancement was 26.7% (66/247). There were 3 (1.2%) adverse events and 6 (2.4%) intra-procedure bleeding incidents. All patients recovered completely after conservative and endoscopic treatment respectively, and no procedure-related mortality was noted. 172 patients had a follow-up duration of more than 6 months and among these, 25 patients had recurrent common bile duct stones. It was significantly correlated to the common bile duct size (p = 0.036)ConclusionsEndoscopic papillary large balloon dilation alone is simple, safe, and effective in dealing with large common bile duct stones in relatively aged and debilitated patients.

Combined ligation with medications was marginally more effective than medication alone in the prevention of gastroesophageal variceal rebleeding with similar adverse effects and mortality.

AIM:To evaluate the factors affecting the early tumor recurrence within one year in cirrhotic patients having a single small hepatocellular carcinoma (HCC) after complete tumor necrosis by radiofrequency ablation (RFA) therapy. METHODS:Thirty patients with a single small HCC received RFA therapy by a RFA 2000 generator with LeVeen needle. Tri-phase computerized tomogram was followed every 2 to 3 mo after RFA. The clinical effects and tumor recurrence were recorded. RESULTS:The initial complete tumor necrosis rate was 86.7%. Twenty-two patients were followed for more than one year. The local and overall recurrence rates were 13.6% and 36.4%, 33.3% and 56.2%, 46.6% and 56.2% at 12, 24 and 30 mo, respectively. No major complication or procedure-related mortality was found. The risk factors for early local tumor recurrence within one year were larger tumor size, poor pathologic differentiation of tumor cells and advanced tumor staging. The age of patients with new tumor formation within one year was relatively younger (55.1±8.3 vs 66.7±10.8, P = 0.029). CONCLUSION:Large tumor size, poor pathologic differentiation of tumor cells and advanced tumor staging are the risk factors for early local tumor recurrence within one year, and young age is the positive predictor for new tumor formation within one year.