Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence

Pereira, Stephen P.; Wilkinson, Mark

doi:10.1016/s0016-5107(13)00001-1

Cited by 4 publications

(2 citation statements)

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“…Both sclerotherapy and ligation can effectively arrest active bleeding from GOVs. 23,24 However, ligation is more-effective than sclerotherapy in decreasing the risk of re-bleeding from GOVs and can achieve variceal obliteration more rapidly with fewer complications such as ulceration, bleeding or oesophageal stricturing. 23 In our study, the use of injection sclerotherapy was not associated with endoscopic stricture formation possibly as a result of the large varices encountered and therefore reduced para-variceal intimal injection and subsequent sclerosis.…”

Section: Discussionmentioning

confidence: 99%

The significance of variceal haemorrhage in Ghana: A retrospective review

Archampong

Tachi

Agyei³

et al. 2015

Ghana Medical Journal

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SUMMARYBackground: This study describes the burden of bleeding oesophageal varices at the main tertiary referral centre in Accra. Design: Retrospective design to describe the endoscopic spectrum and review mortality data following acute upper gastro-intestinal bleeding at the Korle-Bu Teaching Hospital. Endoscopic data was reviewed in the Endoscopy Unit between 2007 and 2010. Mortality data was collated from the Department of Medicine between 2010 and 2013. Interventions: The study questionnaire compiled clinical and demographic characteristics, endoscopic diagnoses, length of hospital admission and treatment regimens. Main outcome measures: Aetiology and time-trend analysis of mortality rates following acute upper gastro-intestinal bleeding; variceal bleeding treatment modalities. Results: On review of the endoscopic diagnoses, gastro-oesophageal varices were identified in 21.9% of cases followed by gastritis 21.7%, duodenal ulcer, 17.0%, and gastric ulcer, 13.2%. Gastro-oesophageal varices were the predominant cause of death from acute upper gastro-intestinal haemorrhage from 46% in 2010 to 76% in 2013. Outcomes following acute upper gastro-intestinal bleeding were dismal with some 38% of fatalities occurring within the first 24 hours. Injection sclerotherapy was the dominant endoscopic modality for secondary prevention of variceal bleeding in comparison with band ligation, mainly as a result of cost and availability. Conclusions: At the tertiary centre in Accra, variceal bleeding is an increasingly common cause of acute upper gastro-intestinal haemorrhage in comparison with previous reviews in Ghana. Its significantly high in-hospital mortality reflects inadequate facilities to deal with this medical emergency. A strategic approach to care with endoscopic services equipped with all the necessary therapeutic interventions will be vital in improving the outcomes of variceal bleeding in Ghana.

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Section: Discussionmentioning

confidence: 99%

The significance of variceal haemorrhage in Ghana: A retrospective review

Archampong

Tachi

Agyei³

et al. 2015

Ghana Medical Journal

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“…Some investigators believe that EVL combined with EIS can eradicate superficial varices in the esophageal mucosa and block deeper traffic branches and small varices in the esophageal wall. In addition, using EVL may reduce the required dose of lauromacrogol, reducing the risk of adverse events (19,20). Several recent studies have used EVL and EIS sequentially or in combination to treat esophageal varices with significant results.…”

Section: Discussionmentioning

confidence: 99%

Esophageal variceal ligation plus sclerotherapy vs. ligation alone for the treatment of esophageal varices

Yue

Wang

et al. 2022

Front. Surg.

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BackgroundThis study aimed to evaluate the efficacy and adverse events of esophageal variceal ligation (EVL) vs. EVL combined with endoscopic injection sclerosis (EIS) in the therapy of esophageal varices.MethodsPatients from January 2017 to August 2021 who received EVL alone (control group) or EVL plus EIS (intervention group) were enrolled in this retrospective study. Efficacy, including rebleeding (clinically hematemesis or melena, confirmed by endoscopy as esophagogastric varices bleeding), variceal recurrence rate (the presence of esophagogastric varices which is needed to be treated again) the number of sessions performed to complete eradication of varices, and safety (adverse events) were compared. The variceal recurrence-associated factors were derived by univariate and multivariate logistic regression analyses.ResultsThe variceal recurrence and rebleeding rate in the intervention group showed significantly lower than the control group (2.6% vs 10.3%, P = 0.006 and 20.7% vs 37.5%, P = 0.029, P = 0.006, respectively, in the 12-month follow-up). The adverse events (fever, chest pain, swallowing, and esophageal stricture) showed no significant difference between the two groups (P > 0.05). Further research showed that the efficacy of the intervention group was better than the control group only achieved in prophylactically endoscopic treatment patients. The diameter of esophageal varices and gastric varices co-exist showed significant effects on variceal recurrence in intervention group [odds ratio (OR) = 15.856; 95% confidence interval (CI), 1.709–160.143; P = 0.016 and OR = 4.5; 95% CI, 1.42–20.028; P = 0.021; respectively].ConclusionsThe intervention group may obtain lower recurrence, rebleeding rate, and fewer sessions performed to complete eradication of varices (number of sessions) and similar incidence of adverse events, especially for prophylactically treatment. Among the intervention group, the diameter of esophageal varices and gastric varices were closely associated with variceal recurrence.

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