Endoscopic ligation vs. sclerotherapy in adults with extrahepatic portal venous obstruction: a prospective randomized study

医学 硬化疗法 结扎 静脉曲张 食管静脉曲张 外科 瓦利克斯 随机对照试验 胃肠病学 前瞻性队列研究 并发症 门脉高压 肝硬化
作者
Showkat Ali Zargar,Gul Javid,Bashir Ahmad Khan,Omar Javid Shah,Ghulam Nabi Yattoo,Altaf Shah,Ghulam Mohammad Gulzar,Jaswinder Singh,N. A. Shah,Hakim Shafi
出处
期刊:Gastrointestinal Endoscopy [Elsevier BV]
卷期号:61 (1): 58-66 被引量:40
标识
DOI:10.1016/s0016-5107(04)02455-1
摘要

Background Endoscopic sclerotherapy is a well-established treatment for bleeding esophageal varices, although it has a substantial complication rate. A prospective randomized trial was conducted to determine whether endoscopic variceal ligation is safer and more effective than sclerotherapy in adults with bleeding esophageal varices because of extrahepatic portal venous obstruction. Methods Thirty-six patients underwent sclerotherapy and 37 had band ligation. Results Ligation and sclerotherapy were equally effective for achieving variceal eradication (94.6% vs. 91.7%, respectively; p = 0.67). However, ligation achieved eradication with fewer endoscopic sessions (3.7 [1.2] vs. 7.7 [3.3]; p < 0.0001) and within a shorter time interval (50.1 [17.7] days vs. 99 [54.8] days; p < 0.0001). In the ligation group, recurrent bleeding was less frequent (2.7% vs. 19.4%; p = 0.028; however, Bonferroni correction for multiple testing removes this significance) and the rate of major complications was lower (2.7% vs. 22.2%; p = 0.014). Total cost per patient was significantly higher in the sclerotherapy vs. the ligation group ($216.6 [71.8] vs. $182.6 [63.4]; p = 0.035). During the follow-up period after variceal eradication, no significant differences were found between the sclerotherapy and the ligation groups with respect to recurrent bleeding (3% vs. 2.9%; p = 1.0), esophageal variceal recurrence (9.1% vs. 11.4%; p = 1.0), and formation of new gastric varices (9.1% vs. 14.3%; p = 0.51). Conclusions Variceal band ligation is superior to sclerotherapy, because it is less costly and achieves variceal eradication more quickly, with lower relative frequencies of recurrent variceal bleeding and complications. Endoscopic sclerotherapy is a well-established treatment for bleeding esophageal varices, although it has a substantial complication rate. A prospective randomized trial was conducted to determine whether endoscopic variceal ligation is safer and more effective than sclerotherapy in adults with bleeding esophageal varices because of extrahepatic portal venous obstruction. Thirty-six patients underwent sclerotherapy and 37 had band ligation. Ligation and sclerotherapy were equally effective for achieving variceal eradication (94.6% vs. 91.7%, respectively; p = 0.67). However, ligation achieved eradication with fewer endoscopic sessions (3.7 [1.2] vs. 7.7 [3.3]; p < 0.0001) and within a shorter time interval (50.1 [17.7] days vs. 99 [54.8] days; p < 0.0001). In the ligation group, recurrent bleeding was less frequent (2.7% vs. 19.4%; p = 0.028; however, Bonferroni correction for multiple testing removes this significance) and the rate of major complications was lower (2.7% vs. 22.2%; p = 0.014). Total cost per patient was significantly higher in the sclerotherapy vs. the ligation group ($216.6 [71.8] vs. $182.6 [63.4]; p = 0.035). During the follow-up period after variceal eradication, no significant differences were found between the sclerotherapy and the ligation groups with respect to recurrent bleeding (3% vs. 2.9%; p = 1.0), esophageal variceal recurrence (9.1% vs. 11.4%; p = 1.0), and formation of new gastric varices (9.1% vs. 14.3%; p = 0.51). Variceal band ligation is superior to sclerotherapy, because it is less costly and achieves variceal eradication more quickly, with lower relative frequencies of recurrent variceal bleeding and complications.
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