Research advances in endoscopic treatment of esophageal and gastric varices / 临床肝胆病杂志

Gastroesophageal variceal bleeding is one of the most common and critical complications of liver cirrhosis, with high rebleeding and mortality rates. Esophageal and gastric varices is a special type of varices, and endoscopic treatment methods for this disease include endoscopic variceal sclerotherapy, endoscopic tissue adhesive injection, and combined sequential therapy, but there are still controversies over the selection of specific treatment method. This article reviews the recent research advances in the endoscopic treatment of esophageal and gastric varices in China and foreign countries.

Clinical effect of endoscopic dense ligation in treatment of esophageal variceal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of endoscopic dense ligation in the treatment of esophageal variceal bleeding. MethodsA total of 156 patients who underwent endoscopic ligation for the first time due to esophageal variceal bleeding caused by cirrhotic portal hypertension in Shijiazhuang Fifth Hospital from July 2015 to June 2016 were enrolled, and according to the treatment method, they were divided into dense ligation group with 76 patients and non-dense ligation group with 80 patients. The patients were followed up for 1-2 years, and a statistical analysis was performed for the eradication or disappearance rate of varices, the number of times of ligation, early rebleeding rate, late-onset rebleeding rate, and the incidence rate of adverse reactions. The t-test was used for comparison of continuous data between two groups, and the chi-square test or Fisher′s exact test was used for comparison of categorical data between two groups. ResultsThere were significant differences between the dense ligation group and the non-dense ligation group in the eradication or disappearance rate of varices (71.05% vs 55.00%, χ2=4.300, P=0.038) and number of times of ligation (χ2=8.511, P=0.014), and there were no significant differences between the two groups in early rebleeding rate (5.26% vs 2.50%, P＞0.05), late-onset rebleeding rate (7.89% vs 10.00%, P＞0.05), recurrence rate of varices (13.16% vs 18.75%, P＞0.05), and incidence rate of adverse reactions (26.32% vs 21.25%, P＞0.05). There was a significant difference in the time to recurrence of varices between the two groups (11.90±1.89 months vs 7.07±1.17 months, t=2.295, P=0.031). Of all 156 patients, 2 (1.28%) died during follow-up, with 1 patient in the dense ligation group and 1 in the non-dense ligation group. There was no significant difference in mortality rate between the two groups (P＞0.05). ConclusionEndoscopic dense ligation is a safe technique for the treatment of esophageal variceal bleeding and is better than non-dense ligation in terms of the disappearance rate of varices and number of times of ligation. Endoscopic dense ligation also allows a longer time to recurrence of varices than non-dense ligation.