Endoscopic variceal ligation as primary prophylaxis for oesophageal variceal bleeding at a Malaysian tertiary hospital

@#Objective: Approximately one-third of patients with esophageal varices will develop bleeding which is a major cause of morbidity and mortality in patients with liver cirrhosis. Currently, the two most widely used modalities to prevent variceal bleeding are pharmacologic and oendoscopic variceal band ligation (EVL). However, EVL has been associated with significant complications. Hence we aim to evaluate and to identify the epidemiology, demography, and complications of EVL at our local Malaysian tertiary hospital. Method: This is a retrospective study of all the patients that had undergone endoscopic variceal surveillance at the Gastroenterology endoscopy unit, Serdang Hospital from 1st January 2015 to 31st March 2017. Patients’ demography, aetiologies of liver cirrhosis, platelet level and international normalised ratio (INR) prior banding procedure, and the post EVL complications were recorded and further analysed with SPSS version 16. Results: In this study, 105 patients were screened for varices. Fifty-five of them had undergone EVL, with a quarter of the patients requiring repeated ligation. There was a male preponderance with 76.4%. 56.4% of patients were in age from 40-59 years. The majority of our patients were of the Malay ethnicity. The major aetiology for liver cirrhosis in our patients was viral hepatitis with Hepatitis C (31.0%), and Hepatitis B (20.0%). Most of our patients had platelet count >50,000 and INR <1.5 prior to EVL. There was no major complication in all of our subjects.

A Case of Rectal Varix Bleeding Treated with Endoscopic Variceal Ligation / 대한소화기내시경학회지

Esophagogastric varices are considered to be the most common complication in patients with portal hypertension. Among ectopic varices, rectal varices are infrequent but potentially serious complication. The etiology and pathogenesis of rectal varices remains controversial. Several kinds of treatment have been performed but standard treatment for rectal varices has not been established. Herein we report a case of rectal varix bleeding treated with endoscopic variceal ligation (EVL) and then evaluated by transrectal color doppler ultrasonography.

Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Although there were many studies to prevent recurrent variceal bleeding, studies about primary prophylaxis of variceal bleeding have been relatively few. We retrospectively evaluated the efficacy of endoscopic variceal ligation (EVL) and propranolol therapy for primary prevention. METHODS: 64 patients who underwent EVL or received propranolol for primary prophylaxis were enrolled and these patients were in the state of Child A or B with large varices and/or red markings on varices. We compared the cumulative bleeding-free rate and the survival rate between EVL group (n=40) and propranolol group (n=24) for primary prophylaxis. RESULTS: The Child classification, the size of varices, and the presence of red color sign were not different statistically between both groups. The mean duration of follow-up in each group was 44 18 and 22 12 months, respectively (p=0.023). The cumulative bleeding- free rate was high in EVL group than in propranolol group (p=0.03). The cumulative survival rate was not different statistically between both groups. CONCLUSIONS: In patients with high-risk varices, EVL therapy prolonged bleeding-free interval compared with propranolol therapy for the primary prophylaxis of variceal bleeding.

Esophagus, Stomach & Intestine; Hemostatic Effect of Histoacryl for Band: induced Esophageal Ulcer Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic variceal ligation(EVL) is a method to manage esophageal varices bleeding and induces mechanical ligation and strangulation of varices by using elastic O-rings. The lower complication rate seen with EVL compared to sclerotherapy can be explained by the more limited degree of local tissue injury induced by EVL. Only the mucosal and submucosal layers are aspirated into cylinder attachment of the ligating devices, thus limiting injury to these layers. But, sometimes band induced ulcer shows massive bleeding. In these cases, endoscopic therapy is very difficult. This study was performed in order to find out the effectiveness of Histoacryl ingection for band-induced esophageal ulcer bleeding, METHODS: We tried to control band-induced bleeding by injecting Histoacryl in 8 cases of band-induced ulcer bleeding. RESULTS: This therapeutic trials show exellent control of bleeding in all cases without rebleeding. CONCLUSIONS: The cyanoacrylate tissue adhesive Histoacryl(N-butyl-2-cyanoacrylate) is a remarkable substance that transforms from its original liquid state into a solid state when mixed with a physiologic medium such as blood. Histoacryl undergoes an instantaneous polymerization reaction and hardens, thereby plugging the varix or bleeding vessel lumen. Rapid hemostasis of an active bleeding occurs and rebleeding of the treated lesion is prevented. We found out that Histoacryl injection is a safe and effective treatment for band-induced ulcer bleeding.

Five Cases of Polypectomy using Endoscopic " O " -ring Ligation / 대한소화기내시경학회지

Endoscopic polypectomy was firstly introduced by Tsuneoka in 1969, and till now this method has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. This method is a very important modality as secondary prevention of malignancy because polyps in gastraintestinal tract are now being considered as precancerous lesion. Polypectomy with snare and electrocautery is mainly used for pedunclated polyps (eg. Yamada Class III, IV), but sessile polyps pose technical difficulty and occasionally cause serious gastrointestinal hemorrhage when resection margin adjacent polyp base. We performed polypectomy with "O"-ring used in endocopic variceal ligation (EVL) to make sessile polyp as semipedunclated form, and also to control bleeding, and then successfully remove it with conventional snare polypectomy. We report these 5 cases with the review of the literature.

Clinical Evaluations for Endoscopic Variceal Ligation in Esophageal Varices Bleeding / 대한소화기내시경학회지

Endoscopic injection sclerotherapy(EIS) has been shown to be the most effective simple method for control of bleeding and eradication of varices. This method has been aceepted widely as a standard treatment of bleeding esophageal varices. However, EIS may be associated with undesirable local and systemic complications. (continue...)