title: Endoscopic treatment of esophageal varices in advanced liver disease patients: band ligation versus cyanoacrylate injection.
abstract: BACKGROUND
  The results of variceal band ligation (VBL) in patients with advanced liver disease are unknown. Cyanoacrylate injection (CI) might have a better outcome than VBL in the treatment of esophageal varices (EV) in these patients.
  
  
  OBJECTIVE
  To compare VBL and CI in the treatment of EV in patients with advanced liver disease.
  
  
  METHODS
  Thirty-eight patients with medium or large EV and Child-Pugh index of at least eight were randomized into two groups: VBL (n=20) and CI (n=18). The patients were followed-up for at least 6 months after the end of treatment. Main outcomes were eradication, bleeding, mortality, complication, and recurrence rates.
  
  
  RESULTS
  Variceal eradication rates were similar in the VBL and CI groups (90 vs. 72%, P=0.39). Mean number of sessions until eradication was 3.17 and 3, respectively. Bleeding episodes until eradication were equally observed in both groups (P=0.17). Mortality (55 vs. 56%, P=0.52) and major complication rates (5 and 17%, P=0.32) were similar. Chest pain with dysphagia was more frequent in the CI group (55.6 vs. 10%, P=0.004). A higher risk of variceal recurrence was observed in the CI group (33 vs. 57%, P=0.04).
  
  
  CONCLUSIONS
  No significant differences between the VBL and CI groups were observed in the treatment of EV in patients with advanced liver disease regarding mortality, variceal eradication, and major complications rates. However, minor complications and variceal recurrence were significantly more common in the CI group. In addition, there was a clear trend toward more bleeding episodes in patients included in the CI group.
authors.affiliation: Federal University of São Paulo, SP, Brazil. marcus.mm@uol.com.br
authors.forename: Marcus Melo Martins
authors.initials: MM
authors.lastname: Santos
authors.forename: Luciano Henrique Lenz
authors.initials: LH
authors.lastname: Tolentino
authors.forename: Rodrigo Azevedo
authors.initials: RA
authors.lastname: Rodrigues
authors.forename: Frank Shigueo
authors.initials: FS
authors.lastname: Nakao
authors.forename: Maria Rachel da Silveira
authors.initials: MR
authors.lastname: Rohr
authors.forename: Gustavo Andrade
authors.initials: GA
authors.lastname: de Paulo
authors.forename: Mario
authors.initials: M
authors.lastname: Kondo
authors.forename: Angelo Paulo
authors.initials: AP
authors.lastname: Ferrari
authors.forename: Ermelindo Della
authors.initials: ED
authors.lastname: Libera
mesh_terms: D000328:Adult; D003487:Cyanoacrylates / Q000009:adverse effects / Q000627:therapeutic use*; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008026:Ligation / Q000009:adverse effects; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates