Outcome of Endoscopic Variceal Band Ligation

Abstract

Introduction: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices.Methods: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017. Consecutive cases who presented in emergency room with acute variceal bleeding due to liver cirrhosis and cases of liver cirrhosis with large varices and red color signs on endoscopic examination were enrolled. They underwent EVL and subsequent re-endoscope at one month interval till the eradication of varices was achieved. Results: Among 83 patients, 15 (18.1%) were of Child Pugh class A, 29 (34.9%) B and 39 (47%) were of C. In 20 (24.1%) cases varices could be eradicated in one session of EVL while 57 (68.7%) required two sessions and in 6 (7.2%) cases it took three sessions. Total average EVL session required for obliteration of esophageal varices was 1.84±0.53. There was only one (1.2%) of early re-bleeding post EVL.Conclusions: EVL is an effective modality of treatment in controlling acute esophageal variceal bleeding, in preventing future variceal bleeding as well as in eradicating esophageal varices, with very few complications.Keywords: acute variceal bleeding; cirrhosis; endoscopic variceal ligation; large varices; red color sign. [PubMed]

Variceal band ligation and its outcome: A single tertiary care centre study.

“…15 Re bleeding from band ligation of the esophageal varices was also the major complication that was observed in short term follow up in a study done by Shahi H et al 16 According to another study done by Shrestha B et al this was seen in only one (1.2%) out of 83 cases. 17 Sarin et al 18 in their study also revealed a highly efficacious outcome in cases with EVL as compared to propranolol, where risk of bleeding was equal in both groups. 18 In the present study esophageal strictures was seen in 2.5% patients which were similar to the study done by Stanley et al and seen in 2% of the cases.…”

Is additional 5-day vasoactive drug therapy necessary for acute variceal bleeding after successful endoscopic hemostasis?

“…Moreover, the overall incidence of very early re-bleeding (28.04%) in placebo group was higher than the documented risks in the recent studies, [ 30 ] partially because most of them were taken in the 1990s; the introduction of multiband devices in recent years may be associated with better short-term outcomes, hence the 5-day adjuvant vasoactive drug after endoscopic hemostasis seems invalidated.…”

Evaluation of endoscopic variceal band ligation sessions in obliteration of esophageal varices

“…Bleeding from esophageal varices is one of the most serious complications of cirrhosis having a high mortality. 10 Patients who survive a first episode of variceal bleeding have a 60% risk of experiencing rebleed. Therefore treatment to prevent first episode of variceal haemorrhage is of utmost importance and all patients surviving a variceal bleed must receive treatment to prevent rebleeding.…”

“…Shrestha B et al in their study reported that in the majority of their patients, varices were eradicated after 2 sessions of band ligation and 24.1% of patients required just 1 session of EVBL whereas in our study in none of the patients the varices were obliterated after 1 session. 10 Haris Alvi et al Another significant finding that came out from out study was that the number of sessions were significantly increased with longer duration of cirrhosis. Its explanation could be that with longer duration of CLD larger varices were formed that took more sessions to obliterate.…”