World Journal of Surgery

, Volume 29, Issue 8, pp 966–973

The Evolving Role of Endoscopic Treatment for Bleeding Esophageal Varices

Original Scientific Reports

DOI: 10.1007/s00268-005-0138-2

Cite this article as:
Krige, J.E.J., Shaw, J.M. & Bornman, P.C. World J. Surg. (2005) 29: 966. doi:10.1007/s00268-005-0138-2

Abstract

The treatment of acute and recurrent variceal bleeding is best accomplished by a skilled, knowledgeable, and well-equipped team using a multidisciplinary integrated approach. Optimal management should provide the full spectrum of treatment options including pharmacologic therapy, endoscopic treatment, interventional radiologic procedures, surgical shunts, and liver transplantation. Endoscopic therapy with either band ligation or injection sclerotherapy is an integral component of the management of acute variceal bleeding and of the long-term treatment of patients after a variceal bleed. Variceal eradication with endoscopic ligation requires fewer endoscopic treatment sessions and causes substantially less esophageal complications than does injection sclerotherapy. Although the incidence of early gastrointestinal rebleeding is reduced by endoscopic ligation in most studies, there is no overall survival benefit relative to injection sclerotherapy. Simultaneous combined ligation and sclerotherapy confers no advantage over ligation alone. A sequential staged approach with initial endoscopic ligation followed by sclerotherapy when varices are small may prove to be the optimal method of reducing variceal recurrence. Overall, current data demonstrate clear advantages for using ligation in preference to sclerotherapy. Ligation should therefore be considered the endoscopic treatment of choice in the treatment of esophageal varices.

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  • J. E. J. Krige
    • 1
    • 2
  • J. M. Shaw
    • 2
  • P. C. Bornman
    • 1
    • 2
  1. 1.Department of Surgery and Medical Research Council, Liver Research CenterUniversity of Cape Town Health Sciences FacultyObservatorySouth Africa
  2. 2.Surgical Gastroenterology UnitGroote Schuur HospitalSouth Africa

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