Comparison of Endoscopic Variceal Ligation versus Combined Ligation and Sclerotherapy for Bleeding Esophageal Varices / 대한간학회지

ABSTRACT

BACKGROUND/AIMS: Combined esophageal variceal ligation and sclerotherapy has been hypothesized to be more effective for the control of bleeding esophageal varices than ligation alone. The present study was to compare the combined therapy with ligation alone in terms of variceal eradication, rebleeding, complication and survival rates in patients with bleeding esophageal varices. METHODS: Thirty-eight patients with bleeding esophageal varices were randomly assigned to receive ligation alone in 20 patients or the combined therapy in 18 patients. The clinical and endoscopic characteristics of patients in the ligation group were similar to those of patients in the combination group. In the combination group, 1-3 mL of ethanolamine was injected proximal to each ligated site. Treatments were repeated every 2- to 3-month until varices were eradicated. RESULTS: No significant differences were found between the ligation and combination groups in variceal eradication rates (70% vs. 72%), numbers of endoscopic sessions required to achieve eradication (3.5+/-0.33 vs. 3.3+/-0.31), rebleeding rates (30% vs. 28%) or 2-yr cumulative survival rates (95% vs. 75%). There were significantly more complications in the combination group (25% vs. 89%, p=0.001). CONCLUSION: Ligation alone is recommended rather than the combined ligation and sclerotherapy because of its lower complication rates.