title: Comparison of characteristics of recurrent esophageal varices after endoscopic ligation versus endoscopic ligation plus sclerotherapy.
abstract: 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.
authors.affiliation: First Department of Surgery, Nippon Medical School, Tokyo, Japan. hiroshiy@nms.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirakata
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimizu
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Takahashi
mesh_terms: 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