Clinical course of esophageal varices treated with endoscopic variceal ligation

Kim, Hwi Young; Park, Joo Kyung; Shim, Joo Hyun; Lee, Jeong Hoon; Park, Young Soo; Kim, Ji Won; Hwang, Jin Hyeok; Kim, Byeong Gwan; Kim, Jin Wook; Kim, Na Young; Lee, Kook Lae; Lee, Dong Ho; Jung, Hyun Chae; Lee, Hyo Suk; Yoon, Yong Bum; Song, In Sung

Abstract

BACKGROUND: Endoscopic variceal ligation (EVL) has been widely used to control acute variceal bleeding. However, eradication of varices with EVL is difficult and rebleeding following successful EVL is frequently problematic. Our aims were to assess the efficacy of EVL for treatment of acute variceal bleeding and to evaluate risk factors associated with rebleeding during follow-up period.
METHODS
One-hundred and five patients were included, who had undergone EVL due to bleeding of esophageal varices. Retrospective analysis was performed about hemostatic success rate, rebleeding rate and risk factors for rebleeding.
RESULTS
Hemostatic success rate was 84.8% (89/105). During follow-up period, eradication of varices was observed in 5.7% (6/105), downgrading in 44.8% (47/105), no change of grade in 35.2% (37/105), and progression of varices was observed in 3.8% (4/105). Mean number of sessions for eradication were 3.3 (range, 2 to 8). Rebleeding was observed in 55.2% (58/105), and rebleeding rate increased with lapse of time, as 24.5% after 3 months, and 37.1% in 6 months, and 50.7% in 12 months, respectively. Multivariate analysis for risk factors of rebleeding showed that number of sessions of variceal ligation was associated with significant reduction of rebleeding (p=0.01, OR 0.184).
CONCLUSION
EVL was effective for hemostasis of acute variceal bleeding, but progression of varices and rebleeding episodes were common. Adequate follow-up evaluation is mandatory, and repeated variceal ligation is required for eradication of varices and secondary prevention of bleeding.