 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 July 1993 | Volume 119 Issue 1 | Pages 1-7
Objective: Comparison of the safety and efficacy of endoscopic sclerotherapy and ligation for the treatment of bleeding esophageal varices.
Design: Randomized, controlled trial.
Setting: An urban county hospital.
Patients: Patients with clinically severe bleeding from esophageal varices.
Intervention: A total of 77 patients were randomly assigned to receive sclerotherapy or ligation at the initial endoscopic examination. Treatment was repeated weekly until variceal obliteration was achieved. After eradication, patients had endoscopic examinations every 3 months or for any episode of rebleeding. Recurrent varices were treated with the originally assigned form of endoscopic therapy.
Measurements: Patients were assessed for further bleeding, for transfusion requirements, for time in hospital, for variceal eradication, for number of treatment sessions required, for complications, for treatment failure, and for risk of death.
Results: Rebleeding tended to be less frequent with ligation than with sclerotherapy: 10 of 38 (26%) compared with 17 of 39 (44%) (difference, 17% [95% CI, –4% to 38%]), but results in the two groups were comparable for blood transfusions, for length of hospital stay, and for risk of death. Comparison of Kaplan-Meier estimates of time to rebleeding and death showed no statistical differences between treatments. Complications were less common in the ligation group: fewer patients in the ligation group had esophageal strictures (0 of 38 compared with 13 of 39 [33%]; P < 0.001) and had complicated esophageal ulcers (1 of 38 [2.6%] compared with 6 of 39 [15%]; P = 0.11). In addition, fewer ligation treatments were required to achieve variceal eradication (4.1 ± 0.3 compared with 6.2 ± 0.4; P < 0.001).
Conclusion: Endoscopic ligation causes statistically fewer local complications than sclerotherapy and achieves variceal eradication more rapidly. Ligation is a viable alternative to sclerotherapy and may have some advantages as a treatment for bleeding esophageal varices.
Author and Article Information
From the University of Southern California School of Medicine, Los Angeles, California.
ARTICLE
Endoscopic Ligation Compared with Sclerotherapy for the Treatment of Bleeding Esophageal Varices
Requests for Reprints: Loren Laine, MD, GI Division (LAC 12-137), Department of Medicine, U.S.C. School of Medicine, 2025 Zonal Avenue, Los Angeles, CA 90033.
Acknowledgments: The authors thank Maria Trujillo and the nursing staff and fellows of the Gastrointestinal Endoscopy Unit at Los Angeles County + University of Southern California Medical Center for their assistance in this study.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  R P Mookerjee and R Jalan All that glitters is not gold Gut, November 1, 2002; 51(5): 623 - 624. [Full Text] [PDF]
|
|
|
|
 |
|
 C.-M. Wu, G. H. Lo, S.-L. Lin, K.-H. Lai, M.-T. Wu, and J.-S. Cheng Esophageal Rupture After Endoscopic Banding Ligation for Esophageal Varices Bleeding J Intensive Care Med, July 1, 2002; 17(4): 195 - 198. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Villanueva, J. Minana, J. Ortiz, A. Gallego, G. Soriano, X. Torras, S. Sainz, J. Boadas, X. Cusso, C. Guarner, et al. Endoscopic Ligation Compared with Combined Treatment with Nadolol and Isosorbide Mononitrate to Prevent Recurrent Variceal Bleeding N. Engl. J. Med., August 30, 2001; 345(9): 647 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Sharara and D. C. Rockey Gastroesophageal Variceal Hemorrhage N. Engl. J. Med., August 30, 2001; 345(9): 669 - 681. [Full Text] [PDF]
|
|
|
|
|
|
A K BURROUGHS, D W PATCH, R JALAN, and P C HAYES Management of variceal haemorrhage in cirrhotic patients Reply Gut, May 1, 2001; 48(5): 738a - 740. [Full Text] [PDF]
|
|
|
|
 |
|
 P J Gow and R W Chapman Modern management of oesophageal varices Postgrad. Med. J., February 1, 2001; 77(904): 75 - 81. [Abstract] [Full Text]
|
|
|
|
|
|
R Jalan and P C Hayes UK guidelines on the management of variceal haemorrhage in cirrhotic patients Gut, June 1, 2000; 46(90003): iii1 - 15. [Full Text] [PDF]
|
|
|
|
|
|
C C Hepworth, S S Kadirkamanathan, F Gong, and C P Swain A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels Gut, April 1, 1998; 42(4): 462 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S A Jenkins, R Shields, M Davies, E Elias, A J Turnbull, M F Bassendine, O F W James, J P Iredale, S K Vyas, M J P Arthur, et al. A multicentre randomised trial comparing octreotide and injection sclerotherapy in the management and outcome of acute variceal haemorrhage Gut, October 1, 1997; 41(4): 526 - 533. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P C Hayes The coming of age of band ligation for oesophageal varices BMJ, May 4, 1996; 312(7039): 1111 - 1112. [Full Text]
|
|
|
|
 |
|
 R. G. Holloway and A. I. Mushlin Intracranial mass lesions in acquired immunodeficiency syndrome: Using decision analysis to determine the effectiveness of stereotactic brain biopsy Neurology, April 1, 1996; 46(4): 1010 - 1015. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Bernat, M. L. Goldstein, and K. M. Viste Jr. The neurologist and the dying patient Neurology, March 1, 1996; 46(3): 598 - 599. [Full Text] [PDF]
|
|
|
|
|
|
R. Bashir, M. Chamberlain, E. Ruby, and F. H. Hochberg T-cell infiltration of primary CNS lymphoma Neurology, February 1, 1996; 46(2): 440 - 444. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A N B McNair, C J Tibbs, and R Williams Recent Advances: Hepatology BMJ, November 18, 1995; 311(7016): 1351 - 1355. [Full Text]
|
|
|
|
|
|
S G J Wiliams and D Westaby Fortnightly Review: Management of variceal haemorrhage BMJ, May 7, 1994; 308(6938): 1213 - 1217. [Full Text]
|
|
|
|
 |
|
 ENDOSCOPIC LIGATION FOR ESOPHAGEAL VARICES Journal Watch (General), July 9, 1993; 1993(709): 4 - 4. [Full Text]
|
|
Article
