title: Comparison of Endoscopic Variceal Ligation and Endoscopic Variceal Obliteration in Patients with GOV1 Bleeding.
abstract: The aim of this study was to compare the efficacy, rebleeding rates, survival, and complications of endoscopic variceal ligation (EVL) with those of endoscopic variceal obliteration (EVO) in patients with acute type 1 gastroesophageal variceal (GOV1) bleeding. Data were collected retrospectively at a single center. A total of 84 patients were selected (20 patients underwent EVL; 64 patients underwent EVO) from February 2004 to September 2011. Their clinical characteristics, laboratory results, vital signs, Child-Pugh score, Model for End-stage Liver Disease (MELD) score, and overall mortality were evaluated. There were no significant differences in baseline characteristics between the two groups. The success rate in initial control of active bleeding was not significantly different between the EVL and EVO groups (18/20 EVL, or 90.0%, compared with 62/64 EVO, or 96.9%; p=0.239). The early rebleeding rate was also not significantly different between the groups (3/18 EVL, or 16.7% compared with 17/62 EVO, or 27.4%; p=0.422). The late rebleeding rate of the EVL group was lower than that of the EVO group (3/18 EVL, or 16.7%, compared with 26/59 EVO, or 44.1%; p=0.042). The time-to-rebleeding was 594 days for the EVL group and 326 days for the EVO group (p=0.054). In the multivariate analysis, portal vein thrombosis (PVT) was a significant risk factor for early rebleeding. Hepatocellular carcinoma (HCC) and previous history of bleeding were significant risk factors for very late rebleeding. In conclusion, EVL is better than EVO in reducing late rebleeding in acute GOV1 bleeding. HCC, PVT, and previous bleeding history were significant risk factors for rebleeding.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hyoung Ju
authors.initials: HJ
authors.lastname: Hong
authors.forename: Chung Hwan
authors.initials: CH
authors.lastname: Jun
authors.forename: Du Hyeon
authors.initials: du H
authors.lastname: Lee
authors.forename: Eun Ae
authors.initials: EA
authors.lastname: Cho
authors.forename: Seon Young
authors.initials: SY
authors.lastname: Park
authors.forename: Sung Bum
authors.initials: SB
authors.lastname: Cho
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Park
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Joo
authors.forename: Hyunsoo
authors.initials: H
authors.lastname: Kim
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Rew
keywords: Endoscopy; Esophageal and gastric varices; Hemostasis; Risk factors