Endoscopic Injection Sclerotherapy and Endoscopic Variceal Ligation for the Treatment of Esophageal Variceal Bleeding

Koo, Cheol; Cho, Cheon Young; Park, Chang Whan; Seo, Kang Seok; Kim, Shin Muk; Kim, Hyun Soo; Choi, Sung Kyu; Rew, Jong Sun; Yoon, Chong Mann

Abstract

BACKGROUND: Esophageal variceal hemorrhage is the most life threatening complication of portal hypertension secondary to chronic progressive liver disease, such as liver cirrhosis. Recently, endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) have been known to be the most effective, simple and safe methods. Gastric varices are sometimes associated with esophageal varices in patients with portal hypertension. However the role of endoscopic sclerotherapy in the treatment of gastric varices has not been adequately evaluated.
METHODS
EIS or EVL was performed in 50 patients with variceal hemorrhage in Chonnam National University Hospital from January 1995 to December 1996. Fifteen patients were treated with EIS, and 35 with EVL. We assessed initial control rate of active variceal bleeding, incidence of rebleeding, complication, the influence of EIS or EVL on coexisting gastric varices and the development of gastric varices after EIS or EVL in the patients.
RESULTS
In all of 50 cases, eradicaion of esophageal varix was performed and variceal bleeding was controlled well. Initial controle of variceal bleeding was made in both groups, but rebleeding rate was much higher in EIS group. The eradication rate was 76% without mortality, the mean session of EIS 2.73, the volumes of sclerosant per person 20.7ml, the volumes of sclerosant per treatment session 7.6 ml. The mean session of EVL was 2.6, the number of bands per person 10.6 and the number of bands per session 4.1. Complications were less common in EVL than EIS; substernal pain (11.4% vs 40.0%), fever (11.4% vs 40.0%)(p<0.05). Primary(present at initial examination) gastric varices were seen in 23 (46%) of 50 patients. In 1 (25.0%) of the 4 patients after sclerotherapy, secondary gastric varices developed. In 2 (18.1%) of 11 patients who diagnosed as coexsting gastric varices in early evaluation, gastric varices were reduced or disappered after EIS. 35 patients with ligation therapy were followed over 6 months, and the development of secondary gastric varices were observed in 11 (31.4%) patients.
CONCLUSION
These results show that both EIS and EVL are effective and safe methods of treatment for esophageal variceal bleeding. EVL was much tolerable methods for the treatment of esophageal variceal bleeding, but the development of secondary gastric varices remains to be solved.