Comparison of characteristics of recurrent esophageal varices after endoscopic ligation versus endoscopic ligation plus sclerotherapy.
OBJECTIVE
The characteristics of recurrent esophageal varices after endoscopic variceal ligation (EVL) plus endoscopic injection sclerotherapy (EIS) versus EVL alone, including the number of additional treatments and patterns of recurrence have been compared.


METHODS
Thirty-four patients with cirrhosis and esophageal varices were treated by EVL alone (EVL group), and 46 patients were treated by EVL followed by extravariceal injection sclerotherapy (EVL+extraEIS group).


RESULTS
Fewer treatment sessions were needed (p<0.005), and more O-rings were required (p<0.0001) in the EVL group than in the EVL+extraEIS group. The 1- and 3-year cumulative recurrence rates were higher in the EVL group (81.3% and 93.8%) than in the EVL+extraEIS group (62.8% and 91.5%) (p<0.05). Endoscopic examination at first recurrence showed varices of a more severe form (p<0.001), but less frequently having the red color sign (p<0.0001), and intramucosal venous dilatation (p<0.0001) in the EVL group than in the EVL+extraEIS group. The number of rehospitalizations for additional treatment was lower (p<0.0001) and more patients could be managed with only endoscopic treatment for recurrent varices in the EVL group than in the EVL+extraEIS group (p<0.05).


CONCLUSIONS
Even if the overall rate of variceal recurrence was higher, fewer treatment sessions were needed, and the number of rehospitalizations for these additional treatments was lower in the EVL group than in the EVL+extraEIS group. Multiple sessions of EVL are an effective strategy for the treatment of esophageal varices.
Yoshida
Hiroshi
H
First Department of Surgery, Nippon Medical School, Tokyo, Japan. hiroshiy@nms.ac.jp
Tajiri
Takashi
T
Mamada
Yasuhiro
Y
Taniai
Nobuhiko
N
Hirakata
Atsushi
A
Kawano
Youichi
Y
Mizuguchi
Yoshiaki
Y
Shimizu
Tetsuya
T
Takahashi
Tsubasa
T
D000368:Aged; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000601:surgery / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015911:Sclerotherapy; D016896:Treatment Outcome