Evaluation of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation for eradication of esophageal varices: a prospective randomized controlled study

Bleeding from esophageal varices is the most severe and lethal complication of portal hypertension. The aim of this work was evaluation of the technique of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation as a new method used for eradication of esophageal varices. This study was conducted on 200 patients out of 294 studied patients. Patients who fulfilled the inclusion criteria were randomized to four groups, Group I: comprised of 50 patients who were subjected to endoscopic injection sclerotherapy, Group II. comprised of 50 patients who were subjected to variceal band ligation, Group III comprised of 50 patients who were subjected to combined endoscopic sclerotherapy and band ligation, Group IV comprised of 50 patients who were subjected to endoscopic band ligation plus argon plasma photocoagulation. Comparison of the endoscopic number of therapeutic session between different studied groups showed that group III was significantly lower in number of sessions. As regard post treatment complications during the follow up period, Group I showed the high incidence of transient pyrexia, transient dysphagia and/or retrosternal pain and ulceration, while group II showed the higher incidence of re-bleeding was demonstrated. The higher incidence of recurrence rate of esophageal varices after eradication during the follow up was detected in group II, while the higher mortality incidence was detected in group I and II, In this study the follow up incidence did not significantly differ between the different studied groups. Scleroligation allows very rapid eradication of varices, low recurrence rate, avoided the disadvantage of high recurrence of band ligation alone, and did not require special skill over sclerotherapy or band ligation but the total cost is higher than that required for sclerotherapy. Also, Band ligation plus argon plasma photocoagulation allows very rapid eradication of varices, and low recurrence rate, with no obvious recorded complications, but it has the disadvantage of being the most expensive technique and requires special machine which is not available except in few endoscopic centers

study of the association between gastric apoptosis and helicobacter pylori [H. pylori] in hepatitis C cirrhotic patients

Recent studies have suggested that bacterial coinfection with Helicobacter species in patients with hepatitis C virus [HCV] may increase the burden of both infections on the hepatobiliary and gastrointestinal tracts. The aim of this study was to evaluate the association between H. pylori infection and gastric apoptosis in patients with hepatitis C cirrhosis. One hundred consecutive patients with dyspepsia; 50 with posthepatitis C cirrhosis and 50 without hepatitis C or cirrhosis, were studied. The presence of H. pylori was tested by urease test and Gram staining of gastric biopsies. The apoptotic index was calculated in gastric biopsies stained with hematoxylin and eosin. A statistical analysis was done to correlate H. pylori infection with gastric apoptosis in both groups. A verbal consent was taken from all patients after explaining the need for endoscopy and H. pylori testing to diagnose their illness. The accuracy of rapid urease test and Gram staining was almost similar in detection of H. pylori. The results of this study have shown that gastric apoptosis increased significantly in cirrhotic patients with H. pylori infection than non-cirrhotic patients with H. pylori infection. This increase was highly significant in comparison with cirrhotic and non- cirrhotic patients without H. pylori infection. Also, non-cirrhotic patients with H. pylori injection had significantly more gastric apoptosis than cirrhotic and non-cirrhotic patients without H. pylori infection. On the other hand, no significant difference was found in gastric apoptosis between cirrhotic and non-cirrhotic patients without H. pylori infection. In conclusion, H. pylori was associated with more gastric apoptosis. Hepatitis C cirrhosis increases gastric apoptosis in patients with H. pylori infection independent of the degree of cirrhosis and concomitant endoscopic findings including portal hypertensive gastropathy [PHG]. There was an association between H. pylori infection and gastric apoptosis specially in hepatitis C cirrhotic patients. This result warrants prospective studies to determine the possible interaction between H. pylori and HCV in increasing gastric lesions in patients with cirrhosis