Microwave coagulation versus sclerotherapy after band ligation to prevent recurrence of high risk of bleeding esophageal varices in Child-Pugh's A and B patients.
BACKGROUND
The combination of endoscopic band ligation (EBL) with either endoscopic injection sclerotherapy (EIS) or thermal therapy has been shown to reduce recurrence of esophageal varices compared to EBL alone. The aim of this prospective trial was twofold: 1) to evaluate the safety and efficacy of EBL used in association with microwave coagulation (MC), a thermal endoscopic therapy method, for treating esophageal varices and preventing recurrence; and 2) to compare these results to the joint application of EBL and EIS.


METHODS
Seventy cirrhotic patients with bleeding esophageal varices were treated with EBL until only thin vessels remained. Thirty-six randomly selected patients received EIS (group A) and 34 received MC (group B) until complete eradication had been achieved. Endoscopic follow-up was performed to detect recurrence. The effectiveness of the treatment was measured using variceal recurrence, rebleeding, intervention complications, and recurrence factors.


RESULTS
During follow-up evaluations averaging 34.9 +/- 11.4 months, no significant differences were found between groups A and B in variceal recurrence (27.7 vs. 17.6%, P = 0.31) or rebleeding (8.3 vs. 0%, P = 0.23). Complications were rare, with no difference detected between groups. The presence of gastric varices influenced recurrence with an odds ratio of 3.9 (95% CI 1.14-13.1, P = 0.029).


CONCLUSIONS
Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence.
Gastroenterological Diagnosis and Research Center Gastrocentro, State University of Campinas, Rua Carlos Chagas 420, Cidade Universitária Zeferino Vaz, Campinas, SP 13031-970, Brazil. leomonici@uol.com.br
Leonardo Trevizan
LT
Monici
José Olympio
JO
Meirelles-Santos
Elza Cotrim
EC
Soares
Maria Aparecida
MA
Mesquita
José Murilo Robilotta
JM
Zeitune
Ciro Garcia
CG
Montes
Jazon Romilson Souza
JR
Almeida
Ademar
A
Yamanaka
Luis Alberto
LA
Magna
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008872:Microwaves / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D055502:Secondary Prevention; D012720:Severity of Illness Index; D055815:Young Adult