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. |
