Korean J Gastroenterol.  2011 May;57(5):302-308. 10.4166/kjg.2011.57.5.302.

Comparison among Endoscopic Variceal Obliteration, Endoscopic Band Ligation, and Balloon-occluded Retrograde Transvenous Obliteration for Treatment of Gastric Variceal Bleeding

• Min SK
• Kim SG
• Kim YS
• Bae JY
• Lee JC
• Lee SH
• Kim HS
• Jeong SW
• Jang JY
• Moon JH
• Lee MS
• Kim BS

• KMID: 1792787
• DOI: http://doi.org/10.4166/kjg.2011.57.5.302

Abstract

BACKGROUND/AIMS
Endoscopic variceal obliteration (EVO), endoscopic variceal ligation (EVL), and balloon-occluded retrograde transvenous obliteration (BRTO) are used to manage gastric variceal bleeding. We compared the re-bleeding rates and survival times of these modalities.
METHODS
The study enrolled 103 patients with suspected gastric variceal bleeding between July 2001 and May 2009. For the management of gastric variceal bleeding, 52 patients underwent EVO; 36, EVL; and 15, BRTO. We evaluated their laboratory results and vital signs, and calculated the Child score, Child classification, and Model for End-stage Liver Disease score. Rebleeding was defined as new-onset hematemesis, hematochezia, melena, or endoscopically proven bleeding. Time-to-rebleeding and survival time were examined by Kaplan-Meyer analysis. A value of p<0.05 indicated statistical significance.
RESULTS
There were no significant differences in baseline characteristics among the three groups. The overall follow-up period averaged 65.13 months. During follow-up, rebleeding occurred in 17 patients (11 EVO, 5 EVL, and 1 BRTO). The times-to-rebleeding were 63.59, 75.79, and 51.41 months for EVO, EVL, and BRTO, respectively, and did not differ significantly (p=0.515). The median survival times were 77.42, 70.14, and 42.79 months, respectively, and also were not different significantly (p=0.978).
CONCLUSIONS
There were no significant differences in the time-to-rebleeding or survival time among EVO, EVL, and BRTO. Further prospective, large-scale studies are needed.

Keyword

Esophageal and gastric varices; Gastrointestinal hemorrhage; Liver cirrhosis; Treatment

MeSH Terms

Adult
Aged
*Balloon Occlusion
Enbucrilate/therapeutic use
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/complications/*therapy
Female
Gastrointestinal Hemorrhage/complications/mortality/*therapy
Humans
Ligation
Liver Cirrhosis/complications
Male
Middle Aged
Recurrence
Retrospective Studies
Severity of Illness Index

Figure

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  Fig. 1. Kaplan-Meier plots of time to rebleeding. EVO, endoscopic variceal obliteration; EVL, endoscopic variceal ligation; BRTO, balloon-occluded retrograde transvenous obliteration.

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  Fig. 2. Kaplan-Meier plots of time to survival. EVO, endoscopic variceal obliteration; EVL, endoscopic variceal ligation; BRTO, balloon-occluded retrograde transvenous obliteration.

Reference

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