Optimality of 2-week Versus 4-week Intervals in Secondary Prophylaxis of Bleeding by Endoscopic Esophageal Variceal Ligation

Abstract

Background and study aim:There is a constant debate about the most appropriate intervals between endoscopic variceal ligation (EVL) sessions that can help achieve variceal obliteration with minimal complications. This study aims to compare 2-weekly and 4-weekly EVL schedule as regards achieving variceal obliteration and prevention of recurrent variceal bleeding.Methods: This study included 204 patients with first attack variceal bleeding randomly allocated in two groups; group I: included 102 patients who underwent 2weekly EVL schedule and group II: included 102 patients who underwent 4weekly EVL schedule. Both groups were followed up till either obliteration or recurrence of bleeding occurred.Results: Group I had significantly higher rate of variceal obliteration at both week 8 (17.5 % vs 0 % P < 0.001) and in week 12 (40 % vs 6.2 % P < 0.001). The overall rate of rebleeding was higher in group II (9.8 % vs 21.6 % p < 0.001). There were no significant differences between the studied groups as regards any of the post banding symptoms, complication, and rehospitalization. Conclusion:The two weekly EVL schedule can help achieve variceal obliteration in shorter duration than 4 weekly schedule and lower overall rate of rebleeding without any significant increase in the post banding symptoms, complication and rehospitalization.