1
|
Shi D, Liu J. Comparing large-volume band ligators and cyanoacrylate injection for gastric variceal eradication: A prospective study. Medicine (Baltimore) 2022; 101:e31939. [PMID: 36401384 PMCID: PMC9678509 DOI: 10.1097/md.0000000000031939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The role of endoscopy in the ligation of gastric varices (GV) remains controversial. This study aimed to evaluate the efficacy of endoscopic band ligation (EBL) using large-volume ligators for the management of non-bleeding GV in patients with cirrhosis. METHODS One hundred fifty-eight patients with non-bleeding GV due to cirrhosis were divided randomly into 2 groups: the EBL group and the endoscopic variceal obturation (EVO) group. The EBL group underwent EBL with large-volume ligators and the EVO group underwent tissue glue injection for the treatment of GV. Follow-up endoscopy was performed 3 to 4 weeks after endoscopic treatment. Patients were followed up for ≥6 months after treatment. Eradication, complication, and recurrence rates were evaluated and compared between groups. RESULTS The type and size of GV were similar in both groups. No significant difference was found in the mean number of treatment sessions or eradication and recurrence rates after 6 months. Ulcer bleeding occurred in 2 EBL patients (2.50%) after ligation, whereas 8 EVO patients (10.25%) experienced bleeding due to glue extrusion. The bleeding rate after endoscopic treatment significantly differed between the groups. In the EVO group, 1 patient developed renal embolism after injection and 2 patients developed sepsis. The prevalence of postoperative fever was significantly higher in the EVO group than in the EBL group. CONCLUSION SUBSECTIONS Large-volume band ligators have similar efficacy to tissue glue for eradicating GV, however, the former is safer. Nevertheless, multicenter studies are needed to further confirm these results.
Collapse
Affiliation(s)
- Ding Shi
- Department of Gastroenterology, Ningbo No. 2 Hospital, Ningbo, China
| | - Jianping Liu
- Department of Gastroenterology, Ningbo No. 2 Hospital, Ningbo, China
- * Correspondence: Jianping Liu, Department of Gastroenterology, Ningbo No. 2 Hospital, Ningbo 315010, China (e-mail: )
| |
Collapse
|
2
|
Wellington J, Canakis A, Kim R. Endoscopic closure devices: A review of technique and application for hemostasis. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii190012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jennifer Wellington
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Canakis
- Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Raymond Kim
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Kapoor A, Dharel N, Sanyal AJ. Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding. Gastrointest Endosc Clin N Am 2015; 25:491-507. [PMID: 26142034 PMCID: PMC4862401 DOI: 10.1016/j.giec.2015.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastroesophageal variceal hemorrhage is a medical emergency with high morbidity and mortality. Endoscopic therapy is the mainstay of management of bleeding varices. It requires attention to technique and the appropriate choice of therapy for a given patient at a given point in time. Subjects must be monitored continuously after initiation of therapy for control of bleeding, and second-line definitive therapies must be introduced quickly if endoscopic and pharmacologic treatment fails.
Collapse
|
4
|
Ivekovic H, Rustemovic N, Brkic T, Ostojic R, Monkemuller K. Endoscopic ligation ("Loop-And-Let-Go") is effective treatment for large colonic lipomas: a prospective validation study. BMC Gastroenterol 2014; 14:122. [PMID: 25005025 PMCID: PMC4099390 DOI: 10.1186/1471-230x-14-122] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/02/2014] [Indexed: 12/30/2022] Open
Abstract
Background Colonic lipomas (CL) are rare benign adipose tumours usually found incidentally during colonoscopy. Endoscopic resection of symptomatic large CL remains controversial, since significant rates of perforation have been reported. In recent years, a novel technique for removal of large CL has been described, consisting of looping and ligating the lipoma with a nylon snare. The aim of our study was to evaluate the safety and efficacy of the “loop and let go” technique for large colon lipomas in a large case series. Methods Consecutive patients referred to our institution for colonoscopy were eligible for the study. The diagnosis of CL was confirmed endoscopically by “pillow” and “naked fat” signs. Following diagnosis, lipomas were looped and ligated by endoloop. Follow-up colonoscopies were scheduled at 1- and 3-months interval. Results A total of 11 patients with large CL were enrolled in study. The indications for the colonoscopy included altered bowel habits (7 patients, 64%), screening for colorectal neoplasm (3 pts, 27%) and lower gastrointestinal bleeding (1 pts, 9%). The median lesion size was 3 cm (range 2,5-6 cm). Lesions were located at the hepatic flexure in 4 patients (36%), cecum and ascending colon (4 pts, 36%), rectosigmoid (2 pts, 18%) and transverse colon (1 pts, 9%). There were no immediate and late complications. On follow-up (median follow-up time 11,9 months, range 8–24), there was one small residual lipoma (<1 cm). Conclusion The results of this study confirm that “loop-and-let-go” technique is safe and efficacious treatment of large colonic lipomas.
Collapse
Affiliation(s)
- Hrvoje Ivekovic
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia.
| | | | | | | | | |
Collapse
|
5
|
Poza Cordon J, Froilan Torres C, Burgos García A, Gea Rodriguez F, Suárez de Parga JM. Endoscopic management of esophageal varices. World J Gastrointest Endosc 2012; 4:312-22. [PMID: 22816012 PMCID: PMC3399010 DOI: 10.4253/wjge.v4.i7.312] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 05/10/2012] [Accepted: 07/01/2012] [Indexed: 02/05/2023] Open
Abstract
The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis
Collapse
Affiliation(s)
- Joaquin Poza Cordon
- Joaquin Poza Cordon, Consuelo Froilan Torres, Aurora Burgos García, Francisco Gea Rodriguez, Jose Manuel Suárez de Parga, Hospital Universitario la Paz, 28046 Madrid, Spain
| | | | | | | | | |
Collapse
|
6
|
Koyama FSC, Hashiba K, Bromberg SH, Cappelanes CA. [Endoscopic treatment of esophageal varices, using pretied loop made with polyamide thread]. ARQUIVOS DE GASTROENTEROLOGIA 2007; 43:328-33. [PMID: 17406764 DOI: 10.1590/s0004-28032006000400016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 05/12/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND [corrected] The elastic band ligation is the method of choice for treatment of esophageal varices. The action mechanism is a mechanical varices compression with thromboses. Based on this concept we developed a ligature method using pretied loop made with polyamide thread for the treatment of esophageal varices. OBJECTIVE The present study describes and evaluates the feasibility of the treatment of esophageal varices by the ligature method using pretied loop made with polyamide thread and analyzes the local changes of the ligations and the results, concerning safety, efficiency and complications of this procedure. PATIENTS AND METHODS Between March, 1998 and May, 2000, 58 patients with esophageal varices were treated with pretied loop, made with polyamide thread (26 patients with schistosomiasis, 11 with alcoholic cirrhosis, 9 with hepatitis C, 5 with hepatitis B, 4 of unknown etiology, 2 with hepatitis B and C, and one with Budd-Chiari syndrome/ 42 men and 16 women/ average age of 47,67 +/- 13,12 years, range 16-74). A plastic tube was attached to the endoscope tip featured as an accessory working channel, allowing the pretied loop made with polyamide thread to be conducted to the esophagus facilitated by a flexible metallic tube, to perform the esophageal varices ligature. A total of 506 ligatures were done, distributed in 223 sections (average of 2,26 +/- 1,08 ligature, varying from 1 to 6 per section). The sessions were perform with the interval of 15 days, until the complete eradication of the esophageal varices. The ecoendoscopy was used as a complementary method to evaluate the varices eradication RESULTS The esophageal varices were treated successfully in all patients. The complete eradication of varices was achieved in 47 (81,03%) patients. In 37 (63,79%) patients the ligatures resulted in pseudopolyps. It was not identified systemic complications or obits. The ecoendoscopy showed thrombosis in the pseudopolyps of 10 patients. The follow-up period was from 4 to 32 months and recurrence of the esophageal varices was observed in 9 (15,51%) patients. The average cost of each ligature was estimated in US$ 1,00. CONCLUSION The study indicates that endoscopic treatment using polyamide thread ligature is a safe, efficient, accessible and low cost method for treatment of esophageal varices treatment, demonstrating a new aspect, that is the obliteration of varices without necrosis, by formation of pseudopolyps.
Collapse
|
7
|
Abstract
Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The first episode of variceal bleeding is associated not only with a high mortality, but also with a high recurrence rate in those who survive. Therefore, management should focus on different therapeutic strategies aiming to prevent the first episode of variceal bleeding (primary prophylaxis), to control hemorrhage during the acute bleeding episode (emergency treatment), and to prevent rebleeding (secondary prophylaxis). These strategies involve pharmacological, endoscopic, surgical, and interventional radiological modalities. This article reviews management of acute variceal bleeding.
Collapse
Affiliation(s)
- Adil Habib
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, MCV Box 980341, Richmond, VA 23298-0341, USA
| | | |
Collapse
|
8
|
Waterman M, Gralnek IM. Preventing complications of endoscopic hemostasis in acute upper gastrointestinal hemorrhage. Gastrointest Endosc Clin N Am 2007; 17:157-67, viii. [PMID: 17397782 DOI: 10.1016/j.giec.2006.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over the last 20 years, endoscopic hemostasis has become the primary method of controlling acute, overt upper gastrointestinal hemorrhage (UGIH) and prevent rebleeding. Although uncommon, procedure-related complications may occur. This article reviews the risks attributable to endoscopic hemostasis in acute UGIH and how to help prevent these complications.
Collapse
Affiliation(s)
- Matti Waterman
- Department of Gastroenterology, Rambam Medical Center, Haifa, Israel
| | | |
Collapse
|
9
|
Rengen MR, Adler DG. Detachable Snares (Endoloop). TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2006. [DOI: 10.1016/j.tgie.2005.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
10
|
Raju GS, Gomez G. Endoloop ligation of a large colonic lipoma: a novel technique. Gastrointest Endosc 2005; 62:988-90. [PMID: 16301055 DOI: 10.1016/j.gie.2005.08.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Accepted: 08/19/2005] [Indexed: 02/08/2023]
Affiliation(s)
- Gottumukkala S Raju
- Departments of Internal Medicine and Surgery, Center for Endoscopic Research, Training and Innovation (CERTAIN), University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
| | | |
Collapse
|
11
|
Abstract
Endoscopic therapy for nonvariceal bleeding should only be used if major stigmata of hemorrhage such as active bleeding and nonbleeding visible vessel are present. Treatment of peptic ulcers with adherent clots is currently controversial. Combination of epinephrine injection and coaptive coagulation is most effective in achieving endoscopic hemostasis. Hemoclips may be preferable for very deep ulcers and large visible blood vessels if coaptive coagulation is anticipated to have a high risk of perforation or bleeding. Adrenaline injection or hemoclip application should be used in bleeding Mallory-Weiss tears, as the safety of thermal methods is not well established. Argon plasma coagulation is the mainstay of endoscopic treatment for superficial lesions such as angiodysplasia and gastric antral vascular ectasia. Both sclerotherapy and band ligation are effective in acute hemostasis of bleeding esophageal varices. Variceal band ligation is preferred due to its superior safety profile and shorter procedure time. Due to the early recurrence of varices after banding ligation, there may be a role for metachronous combination therapy of ligation followed by sclerotherapy. Histoacryl glue is the preferred method of endoscopic hemostasis in gastric varices.
Collapse
Affiliation(s)
- Aric J Hui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N. T., Hong Kong SAR, China.
| | | |
Collapse
|
12
|
Naga MI, Okasha HH, Foda AR, Gomaa MS, Fouad AM, Masoud AG, El-din HH. Detachable endoloop vs. elastic band ligation for bleeding esophageal varices. Gastrointest Endosc 2004; 59:804-9. [PMID: 15173792 DOI: 10.1016/s0016-5107(04)00361-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Variceal bleeding is a serious complication with a mortality rate that ranges from 20% to 50%. Patients who have variceal hemorrhage usually are treated by endoscopic injection sclerotherapy or elastic band ligation to eradicate the varices. Endoloop ligation is a newly developed technique for achieving hemostasis and variceal eradication. This study compared endoloop ligation with elastic band ligation in patients with acute esophageal variceal bleeding. METHODS Fifty patients with acute esophageal variceal bleeding were recruited: 25 were treated by elastic band ligation and 25 by endoloop ligation. RESULTS Although the number of patients in whom bleeding recurred during a follow-up period of 6 months was smaller in the endoloop group (12%) vs. the band group (28%), this difference was not statistically significant. Furthermore, no statistically significant difference was found between the two groups with respect to the number of patients in whom variceal eradication was achieved, the number of treatment sessions required for variceal eradication, or the frequency of variceal recurrence. The total cost for variceal obliteration by endoloop ligation was 342 dollars per patient, whereas, the total cost of variceal eradication by elastic band ligation was 356 dollars per patient. The endoloop had certain technical advantages over band application: a better field of vision, tighter application, good results with junctional varices, and a lack of strain exerted by the device on the endoscope. CONCLUSIONS Endoloop ligation is a promising new technique for management of patients with bleeding esophageal varices.
Collapse
Affiliation(s)
- Mazen Ibrahim Naga
- Department of Internal Medicine and Gastroenterology, Kasr El-Aini Hospitals, Cairo University, Egypt
| | | | | | | | | | | | | |
Collapse
|
13
|
Coumaros D. [Gastrointestinal hemorrhage. Prevention of recurrent bleeding: modalities of endoscopic treatments]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2004; 28 Spec No 2:B83-97. [PMID: 15150500 DOI: 10.1016/s0399-8320(04)95243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Dimitri Coumaros
- Service d'Hépato-Gastroentérologie, Hôpitaux Universitaires, F 67091 Strasbourg Cedex
| |
Collapse
|
14
|
Nietsch H, Lotterer E, Fleig WE. [Acute upper gastrointestinal hemorrhage. Diagnosis and management]. Internist (Berl) 2003; 44:519-28, 530-2. [PMID: 12966782 DOI: 10.1007/s00108-003-0918-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Upper gastrointestinal hemorrhage calls for a team approach. Early endotracheal intubation of unconscious patients helps to prevent aspiration. Erythromycin i.v. 20 min. before emergency endoscopy improves the diagnostic yield. Patients without increased risk of rebleeding may be treated on an outpatient basis. Band ligation is the gold standard for acute variceal bleeding. Terlipressin, somatostatin and octreotide are equally effective but require additional measures for prevention of late recurrence. Somatostatin and analogues used as adjunct to ligation slightly reduce the risk of rebleeding but not of death. Three to seven days of prophylactic antibiotics decrease the risk of uncontrolled or recurrent bleeding. Therapeutic failures are rescued by transjugular intrahepatic portosystemic shunting (TIPS). Patients with nonvaricose bleeding should only be treated when active hemorrhage or a "visible vessel" is found. First line treatment is endoscopic injection of diluted adrenalin or isotonic saline. Thermal coagulation is an alternative. Tissue-destructing sclerosants should be avoided. Clipping and injection of fibrin glue are second and third line measures. Proton pump inhibitors improve endoscopic hemostasis, however, it is unclear whether high i.v. doses are required. H. pylori must be eradicated to prevent late recurrence. Rebleeding is treated endoscopically with angiographic intervention or surgery as rescue measures.
Collapse
Affiliation(s)
- H Nietsch
- Universitätsklinik und Poliklinik für Innere Medizin I, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | | |
Collapse
|
15
|
Sung JJY. Treatment of Variceal Bleeding. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2003; 6:171-180. [PMID: 12628076 DOI: 10.1007/s11938-003-0018-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Mortality due to variceal bleeding secondary to portal hypertension has decreased significantly in the past 2 decades. Endoscopic therapy has been the mainstay of treatment for acute variceal bleeding. Variceal banding ligation has superceded injection sclerotherapy as the most popular treatment modality for acute bleeding. Multiple banding ligators are widely used with high success in restoring hemostasis. The combination of banding and sclerotherapy may be useful in preventing the early recurrence of varices and rebleeding after initial obliteration of varices. Selective vasoactive agents such as somatostatin analogs also improve the outcome of patients. Radiologic shunting has proven to be an effective salvage procedure when endoscopic treatments fail and may be a good intermediate-stage therapy while the patient is waiting for liver transplantation.
Collapse
Affiliation(s)
- Joseph J. Y. Sung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China.
| |
Collapse
|
16
|
Helmy A, Hayes PC. Review article: current endoscopic therapeutic options in the management of variceal bleeding. Aliment Pharmacol Ther 2001; 15:575-94. [PMID: 11328251 DOI: 10.1046/j.1365-2036.2001.00950.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The first episode of variceal bleeding is not only associated with a high mortality, but also with a high recurrence rate in those who survive. Therefore, many studies and randomized clinical trials have focused on different therapeutic strategies aiming to prevent the first episode of variceal bleeding (primary prophylaxis), to control haemorrhage during the acute bleeding episode (emergency treatment), and to prevent re-bleeding (secondary prophylaxis). These strategies involve pharmacological, endoscopic, surgical, and interventional radiological modalities. This review concentrates on the clinical aspects of the endoscopic modalities used to treat oesophageal variceal haemorrhage, including variceal injection sclerotherapy, variceal band ligation, and the use of tissue adhesives (glue) and their substitutes. We also draw conclusions from the available literature regarding the use of endoscopic modalities in primary prophylaxis, emergency treatment, and secondary prophylaxis of variceal re-bleeding. The management of gastric varices and variceal bleeding during pregnancy is also addressed.
Collapse
Affiliation(s)
- A Helmy
- Liver Unit, Department of Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, Scotland, UK.
| | | |
Collapse
|
17
|
Abstract
Many advances in the management of portal hypertension and variceal hemorrhage have occurred during the last 10 years. Effective therapy for primary prevention of variceal hemorrhage is now available in the form of nonselective beta-blockers. Active bleeding should be managed with terlipressin, somatostatin or its analogues, and endoscopic therapy; TIPS and surgery are reserved as salvage therapy for patients who fail endoscopic treatment. Survivors of a variceal hemorrhage should be evaluated for liver transplantation. Specific treatment may be provided with EVL while these patients await transplantation. Patients who fail endoscopic treatment may be treated by TIPS or surgery.
Collapse
Affiliation(s)
- N Garcia
- Department of Medicine, Gastroenterology, and Pharmacology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA
| | | |
Collapse
|
18
|
Bohnacker S, Sriram PV, Soehendra N. The role of endoscopic therapy in the treatment of bleeding varices. Best Pract Res Clin Gastroenterol 2000; 14:477-94. [PMID: 10952810 DOI: 10.1053/bega.2000.0092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The role of endoscopy in bleeding varices is both diagnostic and therapeutic. While sclerotherapy of oesophageal varices remains an established modality, ligation has, in view of its higher safety margin, turned out to be superior in recent years. The excellent initial results of ligation are, however, tainted by a higher recurrence rate in the long term. Since the end-point of treatment is the achievement and maintenance of variceal eradication, the addition of low-dose sclerotherapy following initial eradication by ligation seems to be the optimal method to combine the best of both techniques. In the management of life-threatening bleeding from oesophageal varices and gastric varices, cyanoacrylate remains the only promising non-surgical option. Primary endoscopic prophylaxis is still under evaluation. It is only justified in high-risk patients with large varices bearing red colour signs and in the presence of an intolerance of or contra-indication to propranolol. When indicated, ligation seems to be preferable, and the addition of low-dose sclerotherapy after initial variceal eradication may maintain the benefits accrued in such high-risk patients. The present review examines the available evidence regarding the above issues in the recent literature.
Collapse
Affiliation(s)
- S Bohnacker
- Department of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany
| | | | | |
Collapse
|