Technique and early clinical results of endoscopic variceal ligation (EVL).
Endoscopic variceal ligation (EVL) is a new technique designed to be used instead of sclerotherapy. Small elastic "O" rings ligate varices resulting in their strangulation and eradication. During a 12-month period, EVL was employed in 53 consecutive patients, of whom 36 (68%) had alcoholic cirrhosis 17 were Child-Pugh class A, 22 class B, and 14 class C. Varices were graded from I to IV and repeat treatments were given at 1-2 week intervals until the varices were eliminated. At follow-up ranging from 6-18 months (mean 11.5), 217 EVL treatment sessions had been performed. Of the 13 patients (24%) who died during the study, 11 died during the index hospitalization. Active bleeding was controlled in 19 of 21 patients (90%). Of 40 survivors 13 patients (33%) had 1-2 (mean 1.4) recurrent variceal bleeds while 34 patients had repeat EVL treatment. Elimination of distal varices was achieved in 26 and 7 had reduction of varices from grade III-IV to grade I-II or less. Eradication required a mean of 4.4 EVL sessions in Child's A and B patients and 7.0 sessions in Child's C patients (P less than 0.025). No significant treatment-related complications were observed. EVL appears to control active bleeding, is associated with a low incidence of non-bleeding complications, and may be used as an alternative to sclerotherapy.
Stiegmann
G V
GV
Department of Surgery (Gastrointestinal/Tumor), University of Colorado, Denver.
Goff
J S
JS
Sun
J H
JH
Davis
D
D
Silas
D
D
D002648:Child; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged