[Endoscopic treatment of esophageal varices, using pretied loop made with polyamide thread].
BACKGROUND
[corrected] The elastic band ligation is the method of choice for treatment of esophageal varices. The action mechanism is a mechanical varices compression with thromboses. Based on this concept we developed a ligature method using pretied loop made with polyamide thread for the treatment of esophageal varices.


OBJECTIVE
The present study describes and evaluates the feasibility of the treatment of esophageal varices by the ligature method using pretied loop made with polyamide thread and analyzes the local changes of the ligations and the results, concerning safety, efficiency and complications of this procedure.


METHODS
Between March, 1998 and May, 2000, 58 patients with esophageal varices were treated with pretied loop, made with polyamide thread (26 patients with schistosomiasis, 11 with alcoholic cirrhosis, 9 with hepatitis C, 5 with hepatitis B, 4 of unknown etiology, 2 with hepatitis B and C, and one with Budd-Chiari syndrome/ 42 men and 16 women/ average age of 47,67 +/- 13,12 years, range 16-74). A plastic tube was attached to the endoscope tip featured as an accessory working channel, allowing the pretied loop made with polyamide thread to be conducted to the esophagus facilitated by a flexible metallic tube, to perform the esophageal varices ligature. A total of 506 ligatures were done, distributed in 223 sections (average of 2,26 +/- 1,08 ligature, varying from 1 to 6 per section). The sessions were perform with the interval of 15 days, until the complete eradication of the esophageal varices. The ecoendoscopy was used as a complementary method to evaluate the varices eradication


RESULTS
The esophageal varices were treated successfully in all patients. The complete eradication of varices was achieved in 47 (81,03%) patients. In 37 (63,79%) patients the ligatures resulted in pseudopolyps. It was not identified systemic complications or obits. The ecoendoscopy showed thrombosis in the pseudopolyps of 10 patients. The follow-up period was from 4 to 32 months and recurrence of the esophageal varices was observed in 9 (15,51%) patients. The average cost of each ligature was estimated in US$ 1,00.


CONCLUSIONS
The study indicates that endoscopic treatment using polyamide thread ligature is a safe, efficient, accessible and low cost method for treatment of esophageal varices treatment, demonstrating a new aspect, that is the obliteration of varices without necrosis, by formation of pseudopolyps.
Koyama
Francisco Susumu Corrêa
FS
Serviço de Endoscopia Geral, Hospital Sírio Libanês, São Paulo, SP. drsk@ig.com.br
Hashiba
Kiyoshi
K
Bromberg
Sansom Henrique
SH
Cappelanes
Carlos Alberto
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D004935:Esophageal Diseases / Q000473:pathology* / Q000517:prevention & control; D004932:Esophageal and Gastric Varices / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000473:pathology* / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009757:Nylons; D011127:Polyps / Q000209:etiology / Q000473:pathology; D012720:Severity of Illness Index; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D016896:Treatment Outcome
D009757:Nylons