The combined endoscopic therapy (band ligation and sclerosis) in the eradication of the esophageal varices in the cirrhotic patient: our experience.
OBJECTIVE
In course of liver cirrhosis, esophageal varices develop with an incidence of 8-15% a year, and they constitute a sign of seriousness of portal hypertension. The risk of bleeding is estimated around 10-15% a year. The varices hemorrhage causes a high rate of mortality (around 30-35% for every hemorrhagic event). It follows that it is necessary to plan prophylactic strategies for all the cirrhotic patients, who are at risk of bleeding, or have already bled. Medical treatment with beta-blockers is indicated in the prophylaxis of the first bleeding, while endoscopic treatment represents now the most effective methodology either in acute bleeding, or in the prophylaxis of hemorrhage relapses. The available endoscopic methodologies are the sclerosis or band ligation of esophageal varices. However, unanimous consent about the greater effectiveness of a methodology compared to the other one doesn't exist. As far as the varices eradication is concerned, the authors have done a research to verify if the combined techniques, proposed in various studies appeared in literature, can have some advantages, in comparison with the single methodologies.


METHODS
Thirty-seven patients have been treated: 27 only with sclerosis and 10 with combined methodology (band-ligation followed by sclerosis of the small residual varices).


RESULTS
The group treated with the combined therapy have shown a reduction in relapses and in the main side effects and a better patients' compliance.


CONCLUSIONS
The combination of the two methodologies can have some advantages as for security, easiness of execution, reduction in complications, in varices relapse and, therefore, in the hemorrhagic relapses.
Urso
G
G
Division of Emergency Medicine, Department of Internal Medicine, P.O. S. Marta Villermosa, University of Catania, Catania, Italy. gurso@unict.it
Interlandi
D
D
Puglisi
M
M
Di Prima
P
P
Bertino
G
G
La Rosa
G
G
D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D015911:Sclerotherapy