title: Randomized trial of 1-week versus 2-week intervals for endoscopic ligation in the treatment of patients with esophageal variceal bleeding.
abstract: The appropriate interval between ligation sessions for treatment of esophageal variceal bleeding is uncertain. The optimal interval would provide variceal eradication as rapidly as possible to lessen early rebleeding while minimizing ligation-induced adverse events. We randomly assigned patients hospitalized with acute esophageal variceal bleeding who had successful ligation at presentation to repeat ligation at 1-week or 2-week intervals. Beta-blocker therapy was also prescribed. Ligation was performed at the assigned interval until varices were eradicated and then at 3 and 9 months after eradication. The primary endpoint was the proportion of patients with variceal eradication at 4 weeks. Four-week variceal eradication occurred more often in the 1-week than in the 2-week group: 37/45 (82%) versus 23/45 (51%); difference = 31%, 95% confidence interval 12%-48%. Eradication occurred more rapidly in the 1-week group (18.1 versus 30.8 days, difference = -12.7 days, 95% confidence interval -20.0 to -5.4 days). The mean number of endoscopies to achieve eradication or to the last endoscopy in those not achieving eradication was comparable in the 1-week and 2-week groups (2.3 versus 2.1), with the mean number of postponed ligation sessions 0.3 versus 0.1 (difference = 0.2, 95% confidence interval -0.02 to 0.4). Rebleeding at 4 weeks (4% versus 4%) and 8 weeks (11% versus 9%), dysphagia/odynophagia/chest pain (9% versus 2%), strictures (0% versus 0%), and mortality (7% versus 7%) were similar with 1-week and 2-week intervals.
  
  
  
  One-week ligation intervals led to more rapid eradication than 2-week intervals without an increase in complications or number of endoscopies and without a reduction in rebleeding or other clinical outcomes; the decision regarding ligation intervals may be individualized based on patient and physician preferences and local logistics and resources. (Hepatology 2016;64:549-555).
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sheibani
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Saro
authors.initials: S
authors.lastname: Khemichian
authors.affiliation: Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Linda
authors.initials: L
authors.lastname: Hou
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Yan
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: James
authors.initials: J
authors.lastname: Buxbaum
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Lily
authors.initials: L
authors.lastname: Dara
authors.affiliation: Yale School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
mesh_terms: D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome