title: Prospective randomized trial: endoscopic follow up 3 vs 6 months after esophageal variceal eradication by band ligation in cirrhosis.
abstract: OBJECTIVE
  Endoscopic variceal ligation (EVL) is recommended to treat esophageal varices (EV) in cirrhosis and portal hypertension. A program of endoscopic surveillance is not clearly established. The aim of this prospective randomized trial was to assess the most effective timing of endoscopic monitoring after variceal eradication and its impact on the patient's outcome and on the costs.
  
  
  METHODS
  A hundred and two cirrhotic patients with esophageal varices treated by EVL were evaluated. After variceal eradication patients were randomized to receive first endoscopic control at 3 (Group 1) and 6 (Group 2) months respectively.
  
  
  RESULTS
  Variceal obliteration was achieved in all patients. Variceal recurrence was observed in 28 cases at the first control (29.1%) without difference between the two groups (32% vs 29% in group 1 and 2 respectively, p=0.75). The incidence of large varices is similar in the two groups (33% vs 38% respectively). Using a multivariate analysis, medical therapy with B blockers was the only independent predictor of lowest risk of variceal recurrence [OR 2.30, 95% CI (1.68-3.26)]. Bleeding related to recurrent varices occurred in 3.1% of cases and was associated with portal thrombosis. Child Pugh score ≥8 was the only predictor of mortality (p=0.0002).
  
  
  CONCLUSIONS
  Recurrence of varices after banding ligation is not rare but it is associated with a low risk of variceal progression and bleeding. Accordingly, a first endoscopic control at 6 months after variceal eradication associated with a good risk stratification might be a cost-effective strategy of monitoring.
authors.affiliation: Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: wilmadebernardi@yahoo.it.
authors.forename: Wilma
authors.initials: W
authors.lastname: Debernardi Venon
authors.affiliation: Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: eliachiara@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Elia
authors.affiliation: Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: davidestr@alice.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Stradella
authors.affiliation: Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: mbruno@molinette.piemonte.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bruno
authors.affiliation: Clinical Nutrition and Dietetics Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: mfadda@molinette.piemonte.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fadda
authors.affiliation: Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: eusdeang@hotmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: DeAngelis
authors.affiliation: Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: mrizzetto@molinette.piemonte.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.affiliation: Gastroenterology Unit, San Luigi Gonzaga Hospital, University of Turin, Italy. Electronic address: giorgiomaria.saracco@unito.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Saracco
authors.affiliation: Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: alfredomarzano@yahoo.it.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marzano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Band ligation; Bleeding; Esophageal varices; Portal hypertension