Esophagus, Stomach & Intestine; Comparison of Endoscopic Sclerotherapy & Band Ligation for the Treatment of Esophageal Variceal Bleeding

Chung, Joon Mo; Kim, Sung Kook; Kim, Young Tak; Kwen, Hyek Man; Kum, Min Su; Lee, Chang Hyung; Kwen, Young Oh; Chio, Yong Hwan

Abstract

BACKGROUND/AIMS
Endoscopic sclerotherapy is an accepted treatment for the patients with esogeal variceal bleeding, but endoscopic varicea1 band ligation, introduced by Stiegmann et al in 1986, is a new form of endoscopic treatment method, and may be safer. This study is performed to compare the effectiveness and safety of the two techniques.
METHODS
We compared endoscopic sclerotherapy and endoscopic ligation in 10~8 patients who had recently bled from esophageal varices. We assessed the hemostatic efficacy for bleeding varices, the number of sessions of treatments needed to eradicate varices, the incidence of complications, rebleeding rate and survival rate of the patients by two techniques.
RESULTS
Active bleeding was well controlled by sclerotherapy in all of six patients, and ligation in all of five patients by the initial treatment. The mean number of treatment sessions required to achieve eradication did not significantly differ between sclerotherapy and ligation(2.4+0.8 vs 1.8+ 1.0 sessions). Complications were less comman in ligation than sclerotherapy; chest discomfort(5.6% vs 29.6%), fever(3,7% vs 16.7%), esophageal ulcer(0% vs 5.6%), esophageal stricture(0% vs 3.7%). The rate of recurrent bleeding was significantly lower in the patients treated with ligation(p<0.05). The overall rate of survival was significantly higher in the patients treated with ligation(p<0.05), The days of hospitalization was significantly shorter in the patients treated with ligation than sclerotherapy(14.8+-7.0 vs 21.0+-9.7 days).
CONCLUSIONS
The patients with esophageal variceal bleeding treated with endoscopic ligation have fewer treatment-related complications, lower rates of rebleeding and better survival rates.