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Surgical Endoscopy

, Volume 3, Issue 2, pp 73–78 | Cite as

Technique and early clinical results of endoscopic variceal ligation (EVL)

  • Greg V. Stiegmann
  • John S. Goff
  • John H. Sun
  • Deborah Davis
  • Dean Silas
Original Articles

Summary

Endoscopic variceal ligation (EVL) is a new technique designed to be used instead of sclerotherapy. Small elastic “O” rings ligate varices resulting in their strangulation and eradication. During a 12-month period, EVL was employed in 53 consecutive patients, of whom 36 (68%) had alcoholic cirrhosis 17 were Child-Pugh class A, 22 class B, and 14 class C. Varices were graded from I to IV and repeat treatments were given at 1–2 week intervals until the varices were eliminated. At follow-up ranging from 6–18 months (mean 11.5), 217 EVL treatment sessions had been performed. Of the 13 patients (24%) who died during the study, 11 died during the index hospitalization. Active bleeding was controlled in 19 of 21 patients (90%). Of 40 survivors 13 patients (33%) had 1–2 (mean 1.4) recurrent variceal bleeds while 34 patients had repeat EVL treatment. Elimination of distal varices was achieved in 26 and 7 had reduction of varices from grade III–IV to grade I–II or less. Eradication required a mean of 4.4 EVL sessions in Child's A and B patients and 7.0 sessions in Child's C patients (P<0.025). No significant treatment-related complications were observed. EVL appears to control active bleeding, is associated with a low incidence of non-bleeding complications, and may be used as an alternative to sclerotherapy.

Key words

Esophageal varices Endoscopic ligation Endoscopic sclerotherapy 

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References

  1. 1.
    The Copenhagen Esophageal Varices Sclerotherapy Project (1984) Sclerotherapy after first variceal hemorrhage in cirrhosis: a randomized multicenter trial. N Engl J Med 311: 1594–1600Google Scholar
  2. 2.
    Fleig WE, Stange EF, Ruettenauer K, Ditschuneit H (1983) Emergency endoscopic sclerotherapy for bleeding esophageal varices: a prospective study in patients not responding to balloon tamponade. Gastrointest Endosc 29: 8–14Google Scholar
  3. 3.
    Goff JS, Reveille RM, Stiegmann GV (1988) Endoscopic sclerotherapy vs endoscopic variceal ligation: esophageal symptoms, complications, and motility. Am J Gastroenterol 83: 1240–1244Google Scholar
  4. 4.
    Korula J, Balart LA, Radvan G, Zweiban B, Larson A, Kao W, Yamada S (1985) A prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy. Hepatology 5: 584–589Google Scholar
  5. 5.
    Larson AW, Cohen H, Zweiban B, Chapman D, Gourdji M, Korula J, Weiner J (1986) Acute esophageal variceal sclerotherapy. JAMA 255: 497–500Google Scholar
  6. 6.
    Paquet KJ, Feussner H (1985) Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophageal varices: a prospective controlled randomized trial. Hepatology 5: 580–583Google Scholar
  7. 7.
    Prindiville T, Trudeau W (1986) A comparison of immediate versus delayed endoscopic injection sclerosis of bleeding esophageal varices. Gastrointest Endosc 32: 385–388Google Scholar
  8. 8.
    Sauerbruch T, Weinzierl M, Ansari H, Paumgartner G (1987) Injection sclerotherapy of oesophageal variceal haemorrhage. A prospective long-term follow-up study. Endoscopy 19: 181–184Google Scholar
  9. 9.
    Schuman BM, Beckman JW, Tedesco JF, Griffin J, Assad R (1987) Complications of endoscopic injection sclerotherapy: a review. Am J Gastroenterol 82: 823–829Google Scholar
  10. 10.
    Soderlund C, Ihre T (1985) Endoscopic sclerotherapy v. conservative management of bleeding oesophageal varices: a 5-year prospective controlled trial of emergency and long-term treatment. Acta Chir Scand 151: 499–556Google Scholar
  11. 11.
    Stiegmann GV, Goff JS (1988) Endoscopic esophageal varix ligation (EVL): preliminary clinical experience. Gastrointest Endosc 34: 113–117Google Scholar
  12. 12.
    Stiegmann GV, Cambre A, Sun JH (1986) A new endoscopic elastic band ligating device. Gastrointest Endosc 32: 230–233Google Scholar
  13. 13.
    Stiegmann GV, Sun JH, Hammond WS (1988) Results of experimental endoscopic esophageal varix ligation. Am Surg 54: 105–108Google Scholar
  14. 14.
    Terblanche J, Bornman PC, Kahn D, Jonker M, Campbell J, Wright J, Kirsch R (1983) Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. Lancet II: 1328–1332Google Scholar
  15. 15.
    Westaby D, MacDougall BRD, William R (1985) Improved survival following injection sclerotherapy for esophageal varices: final analysis of a controlled trial. Hepatology 5: 827–830Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • Greg V. Stiegmann
    • 1
  • John S. Goff
    • 2
  • John H. Sun
    • 1
  • Deborah Davis
    • 1
  • Dean Silas
    • 2
  1. 1.Department of Surgery (Gastrointestinal/Tumor)University of Colorado and Denver Veterans HospitalsDenverUSA
  2. 2.Department of Medicine (Gastroenterology)University of Colorado and Denver Veterans HospitalsDenverUSA

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