Percutaneous transhepatic variceal embolization with cyanoacrylate versus endoscopic ligation in management of esophageal variceal bleeding / 中华消化内镜杂志

ABSTRACT

Objective To compare the therapeutic effect of percutaneous transhepatic variceal em-bolization (PTVE) with Cyanoacrylate(TH glue) with that of endoscopic variceal ligatien (EVL) in the treatment of esophageal varlceal bleeding. Methods In this prospective randomized controlled trial, cirrhot-ic patients with acute or recent esophageal variceal bleeding were assigned randomly to PTVE (n = 52) or EVL (n=50) groups. Variants including upper gastrointestinal (UGI) re-bleeding, esophageal variceal re-bleeding, relapse of esophageal variees and survival were evaluated. Results During the follow-up (median 24 and 25 months in the PTVE and EVL groups, respectively), UGI re-bleeding developed in 8 patients (15. 4%) in PTVE group and in 21 (42%) in EVL group (X2 =8. 87, P=0. 005). Recurrent esophageal varices bleeding occurred in 3 patients (5. 8%) in FIVE group and 12 (24%) in EVL group (X2 =5.38, P =0. 012, relative risk 0. 24, 95% confidence interval 0. 05 -0. 74). Reccurent rates of esophageal vari-ces in two groups were 17.3% (9/52) and 52% (26/50), respectively (X2 =13.61, P<0.001). There was no significant difference in survival rate between two groups (X2 = 3.30, P = 0. 054). Conclusion With sufficient embolization of lower esophageal and pefi-esophngeal varices and/or the cardial submucosal and perforating vessels, PTVE was more effective than EVL in the management of esophageal varices recur-rence and re-bleeding.