Skip to main content
SpringerLink
Log in

Long-term outcome of endoscopic variceal band ligation of esophageal varices in patients with chronic liver disease

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

There are scanty data on the long-term outcome of endoscopic variceal band ligation (EVL) for esophageal varices.

Methods

Adult patients suffering from a chronic liver disease (CLD) undergoing EVL of esophageal varices of grade 2 and above between January 2006 and December 2015 were followed up for the recurrence of varices, worsening of portal hypertensive gastropathy (PHG), rebleeding, and mortality. EVL was done as primary prophylaxis of bleeding in 72 and as secondary prophylaxis in 175 patients. All received propranolol after EVL if there was no contraindication.

Results

Two hundred and forty-seven CLD patients (mean age 51.83 ± 11.28 years, 179 males) underwent 306 EVL sessions. The most common etiology was alcohol (53%). Sixty-eight percent of patients had grade 3 esophageal varices 76.5% had PHG. There was no immediate post-EVL bleeding or 30-day mortality. Variceal obliteration was achieved in 100% with 19% recurrence within a mean period of 53.74 ± 27.2 months. PHG worsened in 49.7%. Overall, rebleeding occurred in 13.8%, 4.3% from recurrent varices. There was no difference in variceal recurrence (16.7% vs. 20%) and incidence of rebleeding (9.7% vs. 13.7%) between patients undergoing EVL for primary and secondary prophylaxis. Cumulative rebleeding rates after 1, 5, and 9 years were 1.6%, 9.2%, and 11.4%, respectively. The overall mortality was 85%, mostly from progressive CLD, and only 8.6% was due to rebleeding. On subgroup analysis, the factors significantly associated with rebleeding was Child-Pugh class C and worsened PHG those with mortality were alcohol and Child-Pugh class C.

Conclusion

EVL is effective in the long-term for both primary and secondary prophylaxis of esophageal variceal bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Haq I, Tripathi D. Recent advances in the management of variceal bleeding. Gastroenterol Rep. 2017;5:113–26.

    Article  Google Scholar 

  2. de Franchis R, Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762–8.

    Article  PubMed  Google Scholar 

  3. de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.

    Article  PubMed  Google Scholar 

  4. Sarin SK, Wadhawan M, Agarwal SR, Tyagi P, Sharma BC. Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. Am J Gastroenterol. 2005;100:797–804.

    Article  PubMed  Google Scholar 

  5. Kumar A, Jha SK, Sharma P, et al. Addition of propranolol and isosorbide mononitrate to endoscopic variceal ligation does not reduce variceal rebleeding incidence. Gastroenterology. 2009;137:892–901.

  6. Je D, Paik YH, Gwak GY, et al. The comparison of esophageal variceal ligation plus propranolol versus propranolol alone for the primary prophylaxis of esophageal variceal bleeding. Clin Mol Hepatol. 2014;20:283–90.

  7. Bonilha DQ, Lenz L, Correia LM, et al. Propranolol associated with endoscopic band ligation reduces recurrence of esophageal varices for primary prophylaxis of variceal bleeding: a randomized-controlled trial. Eur J Gastroenterol Hepatol. 2015;27:84–90.

  8. Schepke M, Kleber G, Nurnberg D, et al. Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2004;40:65–72.

    Article  PubMed  Google Scholar 

  9. Shah HA, Azam Z, Rauf J, et al. Carvedilol vs. esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage: a multicentre randomized controlled trial. J Hepatol. 2014;60:757–64.

  10. Pérez-Ayuso RM, Valderrama S, Espinoza M, et al. Endoscopic band ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotic patients with high risk esophageal varices. Ann Hepatol. 2010;9:15–22.

    Article  PubMed  Google Scholar 

  11. Lay CS, Tsai YT, Lee FY, et al. Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis. J Gastroenterol Hepatol. 2006;21:413–9.

    Article  PubMed  Google Scholar 

  12. Tripathi D, Ferguson JW, Kochar N, et al. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology. 2009;50:825–33.

  13. Drastich P, Lata J, Petrtyl J, et al. Endoscopic variceal band ligation compared with propranolol for prophylaxis of first variceal bleeding. Ann Hepatol. 2011;10:142–9.

  14. Lo GH, Chen WC, Chen MH, et al. Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis. Gastrointest Endosc. 2004;59:333–8.

  15. Lui HF, Stanley AJ, Forrest EH, et al. Primary prophylaxis of variceal hemorrhage: a randomized controlled trial comparing band ligation, propranolol, and isosorbide mononitrate. Gastroenterology. 2002;123:735–44.

  16. Norberto L, Polese L, Cillo U et al. A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation. Liver Transpl. 2007;13:1272–8.

  17. de la Peña J, Brullet E, Sanchez-Hernández E, JL, et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology. 2005;41:572–8.

  18. Lo GH, Lai KH, Cheng JS, et al. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology. 2000;32:461–5.

  19. García-Pagán JC, Villanueva C, Albillos A, et al. Spanish variceal bleeding study group: nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: a multicentre randomised controlled trial. Gut. 2009;58:1144–50.

    Article  CAS  PubMed  Google Scholar 

  20. Lo GH, Chen WC, Chan HH, et al. A randomized, controlled trial of banding ligation plus drug therapy versus drug therapy alone in the prevention of esophageal variceal rebleeding. J Gastroenterol Hepatol. 2009;24:982–7.

  21. Villanueva C, Aracil C, Colomo A, et al. Clinical trial: a randomized controlled study on prevention of variceal rebleeding comparing nadolol+ligation vs hepatic venous pressure gradient-guided pharmacological therapy. Alimen Pharmacol Ther. 2009;29:397–408.

    Article  CAS  Google Scholar 

  22. Petrasch F, Grothaus J, Mössner J, Schiefke I, Hoffmeister A. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis. BMC Gastroenterol. 2010;10:5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lo GH, Lai KH, Cheng JS, et al. The effects of endoscopic variceal ligation and proprano-lol on portal hypertensive gastropathy: a prospective, controlled trial. Gastrointest Endosc. 2001;53:579–84.

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, B R Singh Hospital, Kolkata, 700 014, India

    Gautam Ray

Authors
  1. Gautam Ray
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gautam Ray.

Ethics declarations

Conflict of interest

GR declares that there are no conflicts of interest.

Ethics statement

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way are the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers responsible for the results/findings and content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ray, G. Long-term outcome of endoscopic variceal band ligation of esophageal varices in patients with chronic liver disease. Indian J Gastroenterol 38, 69–76 (2019). https://doi.org/10.1007/s12664-019-00938-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-019-00938-7

Keywords

Search

Navigation