[Patient evolution in different stages of hepatic failure submitted to eradication of esophageal varices with endoscopic ligation]. / Evolución de los pacientes en diferentes estadios de insuficiencia hepática sometidos a erradicación de várices esofágicas con ligaduras endoscópicas.

OBJECTIVE: To know the patients' progress with distinct stages of hepatic failure, according to the Child Pugh classification, who underwent esophageal varices eradication with the use of endoscopic band ligation. DESIGN: Descriptive, longitudinal, prospective and comparative study. CENTRE: Endoscopy Department of the Central Military Hospital, Mexico, D.F. METHODS: One-hundred twenty-four patients with esophageal varices and a history of bleeding, were submitted to various band ligation sessions every 4 weeks until the varices were eradicated and control sessions every 3 months. RESULTS: A total of 425 endoscopy sessions were performed of which 239 were ligature applications and 187 control sessions. Eradication of varices was achieved in 100% of the patients. Of the Child A, 2/3 of them were eradicated in one session and the other 1/3 with 2 sessions. The patients of the Child B class, 66% of varices were effaced in one session, 22% in two and 12% in three sessions. In the Child C group, 50% were obliterated in two sessions, 47% with three, 2% needed 4 sessions. The follow-up period was from 4 months being the minimum and 13 months the maximum (mean of 7 months). In 15% of the patients varices recurred. None were from the Child A group. Those pertaining to the Child B group varices reappeared in 7.3% of which 2/3 required another ligation session to eradicate them once again and the other 1/3 were removed in two sessions. In the Child C group the incidence of recidivation was 28%, 43% of these needing one session to eliminate them once again, 50% two sessions and 7% three sessions for complete eradication. Rebleeding appeared in 7.7% of the sample, all of them were from the Child C class. The occurrence of congestive gastropathy before ligature was 42%, and 73% at the conclusion of the follow-up period. Congestive gastropathy developed in 11% of the Child A patients after eradication, 34% of the Child B group and 38.5% of the Child C group. The incidence of gastric varices was 21% before ligature and at the end of the follow-up period 17% more developed gastric varices. None of the Child A patients developed gastric varices, 12% of group B and 24% of group C. From the (n = 124) 22.5% presented dysphagia as a complication which lasted less than one week and in 0.8% mucosal ulcer CONCLUSION: It is possible to eradicate esophageal varices by band ligation independently of the hepatic function reserve. A greater number of sessions is required to eradicate varices in the poor hepatic function group and the incidence of recidivation, rebleeding, and complications that developed such as gastric varices and gastropathy are more frequent in patients with poor hepatic function reserve.

[Endoscopic management of variceal bleeding]. / Manejo endoscópico del sangrado variceal.

For the primary prophilaxis of the variceal bleeding, non selective beta-blockers (propanolol, nadolol) are still the mainstay of treatment but endoscopic ligation are becoming more popular Thanks to modern control procedures the acute bleeding mortality has been reduced. Endoscopic ligation is the prefered method for esophageal varices and the cyanoacrylate injection is the better method for fundic varices. Pharmacological therapy with octreotide or terlipresine seems to be effective, specially if endoscopic treatment is not available. TIPS is a good salvage option in case of endoscopic or pharmacologic failure. Endoscopic ligation seems to be the prefered method for secondary prophylaxis, specially compared with sclerotherapy. Some drugs that reduce portal hypertension are a good alternative. It is still very necessary to define technique and criteria of endoscopic variceal eradication to reduce the great variability reported in published trials.

[Cardias mucosa plication with endoluminal sutures by endoscopy in gastroesophageal reflux disease treatment]. / Plicación de la mucosa del cardias con suturas intraluminales aplicadas por endoscopia en el tratamiento de la enfermedad por reflujo gastroesofágico.

INTRODUCTION: Gastro-esophageal reflux disease is very common among general population, today's standard treatments are medical with proton pump inhibitors and laparoscopic antireflux surgery. Endoscopic gastric plication has been described recently for the treatment of this disease. OBJECTIVE: Review recent advances of the endoscopic gastric plication procedures for the management of gastro-esophageal reflux disease and report our experience. METHODS: Patients with symptomatic gastro-esophageal reflux disease are selected, with esophagitis A and B according to Los Angeles classification and with a De Meester score higher than 26 in 24 hour pH determination. Patients younger than 18 or older than 60 years old are excluded as well as patients with a hiatal hernia greater than 3 cm, previous esophageal or gastric surgery, associated esophageal pathology or a C or D esophagitis. RESULTS: After this procedure the lower esophageal sphincter increases its length, nevertheless there are minimal changes in its pressure, it also diminishes esophageal acid exposure time. Most studies show improvement in symptoms and less drug requirements. In studies with greater follow up period only a minority of patients persists with a good complete response with this treatment. CONCLUSIONS: Prospective randomized trials are needed to determine the real utility of this procedure, aside from these protocols there are no true indications to do this procedure in the general population.