Endoscopic obliteration of esophageal varices by endoscopic variceal ligation is an effective form of secondary prophylaxis.
However, there is no consensus regarding the technical aspects of endoscopic variceal ligation for secondary prophylaxis.
Dr Gavin Harewood and colleagues from Minnesota compared the technical aspects of endoscopic variceal ligation between 1995 and 2003.
The research team assessed aspects such as frequency of sessions, number of sessions and number of bands used.
Patients who rebled following secondary prophylaxis of esophageal varices by endoscopic variceal ligation were compared to those who did not rebleed.
During the study period, 216 patients with acute esophageal variceal hemorrhage underwent emergent endoscopic variceal ligation treatment.
The team reported that 20 patients with follow-up endoscopic variceal ligation for secondary prophylaxis subsequently rebled.
Both rebleeding and non-rebleeding patient groups were well-matched with respect to liver function.
|Median interval between endoscopy sessions in the rebleeding group was 2 weeks|
|Journal of Gastroenterology and Hepatology|
The researchers matched the patients for number and size of variceal trunks, endoscopic stigmata of hemorrhage and beta-blocker usage.
The median interval between endoscopic variceal ligation sessions in the rebleeding group was 2 weeks vs 5 weeks in the non-rebleeding group.
Adjusting for age, gender, and Child-Pugh class, interbanding interval 3 weeks or more was associated with increased likelihood of not rebleeding.
Dr Harewood's team commented, “These findings demonstrate the importance of technical aspects of endoscopic variceal ligation on patient outcome, suggesting the benefit of longer interbanding intervals.”
“Future prospective studies are required to define the optimal intersession interval.”
“Standardizing procedural aspects of endoscopic variceal ligation will aid in objectively evaluating the benefit of this procedure when compared to other modalities such as medical treatment.”