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Microwave coagulation versus sclerotherapy after band ligation to prevent recurrence of high risk of bleeding esophageal varices in Child-Pugh’s A and B patients

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

The combination of endoscopic band ligation (EBL) with either endoscopic injection sclerotherapy (EIS) or thermal therapy has been shown to reduce recurrence of esophageal varices compared to EBL alone. The aim of this prospective trial was twofold: 1) to evaluate the safety and efficacy of EBL used in association with microwave coagulation (MC), a thermal endoscopic therapy method, for treating esophageal varices and preventing recurrence; and 2) to compare these results to the joint application of EBL and EIS.

Methods

Seventy cirrhotic patients with bleeding esophageal varices were treated with EBL until only thin vessels remained. Thirty-six randomly selected patients received EIS (group A) and 34 received MC (group B) until complete eradication had been achieved. Endoscopic follow-up was performed to detect recurrence. The effectiveness of the treatment was measured using variceal recurrence, rebleeding, intervention complications, and recurrence factors.

Results

During follow-up evaluations averaging 34.9 ± 11.4 months, no significant differences were found between groups A and B in variceal recurrence (27.7 vs. 17.6%, P = 0.31) or rebleeding (8.3 vs. 0%, P = 0.23). Complications were rare, with no difference detected between groups. The presence of gastric varices influenced recurrence with an odds ratio of 3.9 (95% CI 1.14–13.1, P = 0.029).

Conclusions

Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence.

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Acknowledgments

The authors would like to thank the Japan International Cooperation Agency (JICA) for providing the microwave system to Gastrocentro-Unicamp.

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Authors and Affiliations

  1. Gastroenterological Diagnosis and Research Center (Gastrocentro), State University of Campinas (Unicamp), Rua Carlos Chagas 420, Cidade Universitária Zeferino Vaz, Campinas, SP, 13031-970, Brazil

    Leonardo Trevizan Monici, José Olympio Meirelles-Santos, Elza Cotrim Soares, Maria Aparecida Mesquita, José Murilo Robilotta Zeitune, Ciro Garcia Montes, Jazon Romilson Souza Almeida & Ademar Yamanaka

  2. Department of Medical Genetics, State University of Campinas (Unicamp), Campinas, SP, Brazil

    Luis Alberto Magna

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  1. Leonardo Trevizan Monici
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Correspondence to Leonardo Trevizan Monici.

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Monici, L.T., Meirelles-Santos, J.O., Soares, E.C. et al. Microwave coagulation versus sclerotherapy after band ligation to prevent recurrence of high risk of bleeding esophageal varices in Child-Pugh’s A and B patients. J Gastroenterol 45, 204–210 (2010). https://doi.org/10.1007/s00535-009-0134-7

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  • DOI: https://doi.org/10.1007/s00535-009-0134-7

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