title: Long-term efficacy of endoscopic ligation plus cyanoacrylate injection with or without sclerotherapy for variceal bleeding.
abstract: OBJECTIVE
  This study aimed to evaluate the long-term outcomes and efficacy of continued ligation plus cyanoacrylate injection compared with those of combined ligation and sclerotherapy plus cyanoacrylate injection for secondary prophylaxis of variceal bleeding in cirrhotic patients with concomitant esophageal and gastric varices.
  
  
  METHODS
  Medical records of the patients who were admitted for variceal bleeding due to liver cirrhosis were retrospectively reviewed and their related data was collected. The patients were divided into two groups, including the continued ligation plus cyanoacrylate injection group [the sclerotherapy (-) group] and the combined ligation and sclerotherapy plus cyanoacrylate injection group [the sclerotherapy (+) group]. The Kaplan-Meier survival analysis was conducted and log-rank test was used to compare the differences between the two groups.
  
  
  RESULTS
  Altogether 125 patients were enrolled between 1 April 2004 and 31 December 2012. After a median follow-up of 23.4 months, no significant difference was observed between the two groups in regard to variceal rebleeding (29.7% vs 47.5%, P = 0.097) and mortality (12.5% vs 14.8%, P = 0.879). Among patients with ascites the cumulative rebleeding rate was significantly lower in the sclerotherapy (-) group (26.3% vs 59.4%, P = 0.020). A relapse of bleeding after the initial endoscopic therapy was an independent prognostic factor of rebleeding (P = 0.004). Portal thrombosis was an independent prognostic factor for mortality (P = 0.044).
  
  
  CONCLUSIONS
  No superiority of combined ligation and sclerotherapy compared with continued ligation and cyanoacrylate injection for secondary prophylaxis of variceal bleeding is observed.
authors.affiliation: Department of Gastroenterology, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Shanghai, China.
authors.forename: Xiao Qing
authors.initials: XQ
authors.lastname: Zeng
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Li Li
authors.initials: LL
authors.lastname: Ma
authors.affiliation: Department of Gastroenterology, Shanghai, China.
authors.forename: Xiao Quan
authors.initials: XQ
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology, Shanghai, China.
authors.forename: Yu Jen
authors.initials: YJ
authors.lastname: Tseng
authors.affiliation: Department of Gastroenterology, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Shanghai, China.
authors.forename: Tian Cheng
authors.initials: TC
authors.lastname: Luo
authors.affiliation: Department of Gastroenterology, Shanghai, China.|Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Shi Yao
authors.initials: SY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D003487:Cyanoacrylates / Q000008:administration & dosage*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D055502:Secondary Prevention; D013997:Time Factors; D055815:Young Adult
chemical_list: D003487:Cyanoacrylates
keywords: esophageal and gastric varices; liver cirrhosis; sclerotherapy; secondary prophylaxis; variceal bleeding