Long-term outcome of endoscopic variceal band ligation of esophageal varices in patients with chronic liver disease
- 5 Downloads
There are scanty data on the long-term outcome of endoscopic variceal band ligation (EVL) for esophageal varices.
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.
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.
KeywordsBand ligation Chronic liver disease Esophageal varices India
Compliance with ethical standards
Conflict of interest
GR declares that there are no conflicts of interest.
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.
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.
- 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.Google Scholar
- 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.Google Scholar
- 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.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.Google Scholar
- 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.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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.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.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.Google Scholar