Combined endoscopic and radiologic intervention to treat esophageal varices.
OBJECTIVE
In patients with esophageal varices, we investigated the impact on long-term outcome of combining interventional radiologic procedures with endoscopic therapy.


METHODS
Of 133 patients with esophageal varices, 86 were treated with endoscopic therapy alone and 47 underwent endoscopic therapy in addition to interventional radiologic procedures. End-points considered during 5-years of follow-up included recurrent bleeding and retreatment.


RESULTS
Bleeding rates were 24.4% in the endoscopy group and 25.4% in the combined therapy group. Retreatment rates at 1, 3, and 5 years for the endoscopy group versus the combined therapy group were 40.7% versus 30.3%, 72.0% versus 67.5%, and 88.2% versus 80.5%, respectively, representing no significant difference between two groups. However, cumulative retreatment rates in Child's class C cases were significantly lower in the combined therapy group than in the endoscopy group (P = 0.025). Patients who had combined therapy which included all embolizing techniques showed significantly lower retreatment rates than patients treated with endoscopy alone (P = 0.05).


CONCLUSIONS
In combination, interventional radiologic and endoscopic therapies are highly effective and can improve long-term outcome in patients with esophageal varices, especially those with poor liver function and those who undergo embolization by all techniques.
Taniai
N
N
First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyou-ku, Tokyo 113-8603, Japan.
Onda
M
M
Tajiri
T
T
Yoshida
H
H
Mamada
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011172:Portography; D015911:Sclerotherapy / Q000379:methods*; D013154:Spleen / Q000098:blood supply; D016896:Treatment Outcome