Endoscopic variceal ligation versus conservative treatment for patients with hepatocellular carcinoma and bleeding esophageal varices.
BACKGROUND
Endoscopic variceal ligation (EVL) is currently a favored treatment for control of bleeding from esophageal varices. However, little is known about the treatment of bleeding varices in hepatocellular carcinoma.


METHODS
EVL was performed in 16 patients with bleeding esophageal varices due to concomitant hepatocellular carcinoma. Treatment results were compared with those of another 23 patients who were conservatively treated.


RESULTS
Comparing the two groups, ligation significantly reduced the risk of fatal bleeding (44% vs 70%; P < 0.05). Significantly fewer patients in the ligation group died at the time of the index hemorrhage (11% vs 52%; P < 0.05). Rebleeding occurred in 44% of the ligation group and 73% in the control group (P > 0.05). The mean days of survival were 40 +/- 20 (range, 7 to 103) in the ligation group and 20 +/- 30 (range, 1 to 136) in the control group (P = 0.08). In the absence of portal vein thrombosis, ligation significantly reduced the rebleeding rate (17% vs 50%, P < 0.05) and the mortality rate (0% vs 100%, P < 0.05).


CONCLUSIONS
EVL is a good choice for palliation in patients with esophageal variceal bleeding and hepatocellular carcinoma. Aggressive use of EVL may be tried in those patients without portal venous thrombosis.
Chen
C Y
CY
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Chang
T T
TT
Lin
C Y
CY
Shin
J S
JS
Chem
C Y
CY
Chi
C H
CH
Sheu
B S
BS
Lin
X Z
XZ
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000209:etiology; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008026:Ligation / Q000379:methods; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011169:Portal Vein; D012008:Recurrence; D016019:Survival Analysis; D013927:Thrombosis / Q000150:complications; D016896:Treatment Outcome