Combined Endoscopic Band Ligation and Sclerotherapy Versus Endoscopic Sclerotherapy Alone for Treatment of Bleeding Esophageal Varices
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Background and Study Aims: Combined endoscopic band ligation (EBL) and endoscopic injection sclerotherapy (EIS) has been introduced as more effective method for treatment of bleeding esophageal varices as compared to endoscopic injection sclerotherapy alone. This study compared the efficacy, complications and mortality rate of combination therapy to sclerotherapy alone. Patients and Methods: All patients admitted to Cairo Liver Center with bleeding esophageal varices were randomly assigned to be treated initially with EBL+EIS or EIS until control of bleeding. A follow-up treatment with EIS was performed every two weeks until eradication of varices. Patients were followed for 14 months to detect complications and recurrence. Results: Both methods were comparable regarding the risk of persistent bleeding and mortality after the initial treatment. Patients with bilharziases found to be at higher risk of persistent bleeding (Oft= 4.4, 95%CI= 1.2-16.0, P= 0.0239) at the end of the initial therapy as compared to non-bilharzial patients. Those of 45 years old were at 5.5% more risk (95% Cl= 1.1-26.7, P= 0.0359) of mortality than younger age groups and patients in Child-Pugh class C were at 6.4 times more risk (95% Cl= 1.9-22.0, P=0.0031) to die than those in Child-Pugh class B. Patients in EBL+EIS group showed shorter duration for eradication of varices than EIS group (median= 8 vs. 12), approximately triple chance for eradication (95% CI= 1.9-5.2, P= 0.0000) and less probability for non-eradication at each follow-up period. Late complications and recurrence were minimal and did not differ between the two groups. Conclusion: Combined EBL and EIS is superior to EIS alone in eradication of varices in a shorter duration with no difference in complications between the two groups. Bilharzial patients were at high risk of persistent bleeding compared to non-bilharzial.