Clinical effect of esophageal variceal ligation in treatment of esophageal variceal bleeding in patients with liver cirrhosis / 临床肝胆病杂志

ABSTRACT

Objective To investigate the clinical effect of endoscopic esophageal variceal ligation (EVL)in the treatment of esophageal variceal bleeding (EVB)in patients with liver cirrhosis.Methods A total of 84 liver cirrhosis patients with EVB who were admitted to The Third People′s Hospital of Shenzhen,Guangdong Medical University,from December 2010 to July 2013 were divided into ligation group (group A,treated with EVL combined with somatostatin and esomeprazole)and control group (group B,treated with somatostatin and es-omeprazole),with 42 patients in each group.The hemostasis rate,rebleeding rate,incidence rate of complications,and mortality rate were observed in both groups,as well as the variceal eradication rate after EVL and risk factors for early rebleeding.The t -test was used for com-parison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups;the Mann -Whitney U test was used for comparison of non -normally distributed continuous data between two groups,the Wilcoxon signed -rank sum test was used for comparison within each group,and the Kruskal -Wallis H test was used for comparison between multiple groups.The chi -square test or Fisher′s exact test was used for comparison of categorical data between groups.The Kaplan -Meier method was used to calculate survival rates,and the log -rank test was used to compare survival rates between groups.The logistic regression meth-od was used to investigate the influencing factors for dichotomous data.Results There was a significant difference in the hemostasis rate be-tween groups A and B (97.62% vs 80.95%,P =0.029).Compared with group B,group A had significantly lower rebleeding rates in 1 -2 years (15.38% vs 38.89%,χ2 =5.323,P =0.021)and 2 -3 years (15.38% vs 48.48%,χ2 =10.448,P =0.001).A total of 14 patients (33.33%)in group A and 7 patients (16.67%)in group B experienced adverse events,and 4 patients in group A and 9 patients in group B died within 3 years.Group A had significant improvements in the levels of alanine aminotransferase (ALT)and aspartate amin-otransferase at 1 week after treatment (Z =-2.177 and -2.044,P =0.029 and 0.041).Both groups had significant improvements in pro-thrombin time activity (PTA),prothrombin time (PT),international normalized ratio (INR),and albumin at 1 week after treatment (group AZ =-4.007,t =3.866,Z =-4.152,t =-4.623,all P <0.001;group Bt =-5.069,Z =-3.870,Z =-3.909,Z =-5.245,all P <0.001).There was a significant difference in PTA at 1 week after treatment between the two groups (Z =-3.902,P <0.001).In group A,the overall disappearance rate of varices was 85.71% and the recurrence rate was 14.29%,and there was a signifi-cant correlation between the Child -Pugh score and diameter of the portal vein (F =3.319,P =0.047).Symptoms on admission,length of hospital stay,Child -Pugh score,spontaneous bacterial peritonitis,diameter of the portal vein,PT,INR,and ALT were risk factors for ear-ly rebleeding after ligation (all P <0.05).Conclusion EVL is a safe and effective method for the treatment of EVB in patients with liver cirrhosis and causes few complications.