Secondary prophylaxis of esophageal variceal treatment: Endoscopic sclerotherapy, band ligation and combined therapy--long-term results.
OBJECTIVE
To evaluate the long-term results of endoscopic sclerotherapy and endoscopic band ligation in secondary prophylaxis on variceal eradication and to evaluate the effectiveness of endoscopic sclerotherapy and endoscopic band ligation combination in resistant cases.


METHODS
The results of the patients who underwent endoscopic sclerotherapy (n=47 31M/16F, 49.9+/-16.1 years) and endoscopic band ligation (n=72 56M/16F, 46.6+/-14.1 years) were compared. The results of patients whose varices could not be eradicated who were treated with endoscopic band ligation and combined endoscopic sclerotherapy (combined group, n=62 49M/13F, 48.8+/-12.7 years) are also given. Patients were evaluated for portal hypertension etiology, Child score, fundal varices-portal hypertensive gastropathy presence according to first and last endoscopic findings, varices eradication, rebleeding, recurrence and complication rates.


RESULTS
181 patients were followed for 35.2+/- 25.6 (6-123) months. Varices eradication and recurrence rates were 93.6% and 44.7% for endoscopic sclerotherapy, and 90.3% and 47.2% for endoscopic band ligation (p>0.05). The number of sessions for eradication were 6.6+/-4.0 and 2.5+/-1.6 for endoscopic sclerotherapy and endoscopic band ligation groups, respectively (p<0.05). Rebleeding rates were 16.3% for endoscopic sclerotherapy and 6.1% for endoscopic band ligation (p>0.05). In the combined group, although the rebleeding rate was 34.4%, which was as expected significantly higher than that of endoscopic sclerotherapy and endoscopic band ligation, variceal eradication and the recurrence rates were 82.3% and 50.0%, similar to endoscopic sclerotherapy and endoscopic band ligation, and the number of sessions for eradication was 6.8+/-3.5.


CONCLUSIONS
Endoscopic band ligation is the most suitable method for varices eradication, but there is a group of patients resistant to endoscopic band ligation. In this patient group, the addition of endoscopic sclerotherapy to endoscopic band ligation was a suitable and effective technique in order to achieve variceal eradication.
Kuran
Sedef
S
Gastroenterology Clinic, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. sedefozdal@hotmail.com
Oğuz
Dilek
D
Parlak
Erkan
E
Asil
Mehmet
M
Ciçek
Bahattin
B
Kiliç
Mesut
M
Dişibeyaz
Selçuk
S
Sahin
Burhan
B
D000328:Adult; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000517:prevention & control* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult