COMPARISON OF SINGLE VERSES MULTIPLE SESSION BAND LIGATION FOR THE TREATMENT OF BLEEDING OESOPHAGEAL VARICES
AbstractBackground: Cirrhosis of liver is the leading cause of portal hypertension in this part of the globe. Around thirty percent of the patient with portal hypertension develops complications. Oesophageal variceal bleeding is a serious complication of portal hypertension. Oesophageal variceal band ligation (EVBL) has become the standard of care for patients with bleeding oesophageal varices. Multiple sessions of band ligation are cumbersome and expensive. Methods: Sixty patients with acute variceal bleed were enrolled in this randomized control trial. Patients were randomly assigned to multi-session (group A) or single session (group B) oesophageal variceal band ligation group. All patients were followed for re-bleeding and mortality up to three months. Results: Re-bleeding occurred (20%) in group A and (17%) in group B patients, respectively. Mortality was 10% in group A and 7% in group B patients. Variceal obliteration was better in group A 63% than group B 24% (p<0.05). Conclusion: Single session band ligation was comparable for rates of re-bleeding and mortality to multi-session band ligation.Keywords: Cirrhosis of Liver, Oesophageal Varices, Band Ligation
Bukhtiari N, Hussain T, Iqbal M, Malik AM, Quraishi AH, Hussain A. Hepatitis B and C single and co-infection in chronic liver disease and their effect on the disease pattern. J Pak Med Assoc 2003;53:136–40.
Niaz Z, Tahir A, Cheema M, Latif M, Razzaq A, Butt AR, et al. Correlation of grade of oesophageal varices with ultrasound measured portal vein diameter and splenic index. Pak Postgraduate Med J 2004;15:100–3.
Triantos CH, Manolakopoulos S. Endoscopic treatment of gastroesophageal varices. Ann Gastroenterol 2006;19(2):116–20.
Robert C. Lowe, Noman D. Grace. Primary prophylaxis of variceal hemorrhage. Clin Liver Dis 2001;5:665–76.
Dib N, Oberti F, Cales P. Current management of the complications of portal hypertension: variceal bleeding and ascites. CMAJ 2006;174:1433–43.
Jensen DM. Endoscopic screening for varices in cirrhosis: findings, complications and outcomes. Gastroenterology 2002;122:1620–30.
De Gottardi A, Dufour JF. Oesophageal and fundicvariceal bleeding. Ther Umsch 2006;63:295–9.
McKiernan PJ. Treatment of variceal bleeding. Gastroentes Endosc Clin North Am 2001;11:789–12.
Khurram M, Khaar HTB, Haron Z, Umar M, Javed S, Asghar T et al. A 12 years audit of upper gastrointestinal endoscopic procedures. J Coll Physicians Surg Pak 2003;13:321–4.
Leszczyszyn J, Lebski I, Massopnst R, Skoczylas M, Jarms W. Results of rubber band ligation of esophageal varices. Med Sci Monit 2001;7:287–91.
Jutabha R, Jensen DM, Martin P, Savides T, Huy-Han S, Gorhbein J. Randomized study comparing banding and propranolol to prevent initial variceal hemorrhage in cirrhotics with high risk esophageal varices. Gastroenterology 2005;126:870–81.
Farag M, Omar N, Salama M, Waked I, Saleh SM. Efficacy of a single session of band ligation in prevention of re-bleeding from esophageal varices. J Gastroenterol Hepatol 2004;19(Suppl):A30.
Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS. Predictors of early re-bleeding and mortality after acute variceal hemorrhage in patients with cirrhosis. Gut 2008;57:814–20.
Hou MC, Lin HC, Liu TT. Antibiotic prophylaxis after endoscopy therapy prevents rebleeding in acute variceal hemorrhage: A randomized trial. Hepatology 2004;39:746–53.
Sarwar S, Dilshad A, Khan AA. Predictive value of Rockall score for rebleeding and mortality in patients with variceal bleeding. J Coll Physician Surg 2007;17:253–6.
Chen WC, Lo GH, Tsai WL, Hsu PI, Lin CH, Lai KH. Emergency endoscopic variceal ligation versus somatostatin for acute esophageal variceal bleeding. J Clin Med Assoc 2006;69:60–7.
D’Amico G, deFranchis R. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003;38:599–612.
Altintas E, Sezgin O, Kagar S. Esophageal variceal ligation for acute variceal bleeding: Results of three years follow up. The Turkish J Gastroenterology 2004;15:245–50.
Caldera EE, Dorantes RAA, Ortiz GJA. Patient evolution in different stages of hepatic failure submitted to eradication of esophageal varices with endoscopic ligation. Rev Gastroenterol Mex 2005;70:33–7.
Ramirez FC, Colon VJ, Landan D, Grade AJ, Evanich E. The effects of the number of rubber bands placed at each endoscopic session upon variceal outcomes. A prospective, randomized study. Am J Gastroenterol 2007;102:1372–6.