Early effects of esophageal injection sclerotherapy and band ligation on coagulation and bleeding profile

ABSTRACT

The present study was performed with the aim of comparing the systemic coagulopathy and bleeding profile following endoscopic variceal sclerotherapy with 5% ethanolamine oleate versus that following band ligation, where they were estimated just before then one hour and 2 hours after the procedure. Twenty patients were randomly allocated into two groups, the ligation group [10 patients],with a mean age of [48.5 +/- 10.9 years] and the sclerotherapy group [10 patients],with a mean age of 44 +/- 8.5 years. In the ligation group, no statistically significant differences were obtained on comparing coagulation and bleeding parameters through out the study time.As regards the sclerotherapy group, on comparing these parameters one hour after the procedure to those just before it, there were significant decrease in platelet count, factor VIII concentration, prothrombin concentration and significant prolongation of prothrombin time, partial thromboplastin time. Non significant results were obtained on comparing the tested parameters 2 hours after the procedure with those one hour after it. While on comparing parameters 2 hours after sclerotherapy to those just before it, there were significant changes of the same parameters changed before, denoting that these changes occuring one hour after sclerotherapy are maintained till the second hour. On comparing both groups of patients with each other, regarding parameters one hour after the procedure to those just before it and also 2 hours after the procedure to those just before it, there were significant prolongation of prothrombin time, partial thromboplastin time and highly significant decrease in prothrombin concentration in the sclerotherapy group. In conclusion, only the group of patients undergoing elective intravariceal sclerotherapy using 5% ethanolamine oleate, showed mild changes in the coagulation and bleeding profile. These changes were found one hour after the procedure and were maintained up to the second hour. Thus, endoscopic variceal ligation appears to be a technique of less negative impact on coagulation and bleeding profiles when compared with sclerotherapy and may be considered as the procedure of choice for treatment of bleeding esophageal varices especially in patients with marked thrombocytopenia and coagulation abnormalities, because in such patients scierotherapy might worsen the preexisting coagulation abnormalities and precipitated haemorrhagic complication