Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices
Background: Endoscopic band ligation combined with sclerotherapy has been postulated to be superior to ligation alone for the treatment of esophageal variceal bleeding. Methods: A randomized trial of ligation versus combined ligation and sclerotherapy was designed to determine whether combined thera...
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| Veröffentlicht in: | Gastrointestinal endoscopy 1999-07, Vol.50 (1), p.1-6 |
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| creator | Al Traif, Ibrahim Fachartz, Fayiz Sbeih Al Jumah, Abdulrahman Al Johani, Mishall Al Omair, Ahmed Al Bakr, Fahad Al Knawy, Bandar El Hafi, Ahmed Khan, Mohammed H. |
| description | Background: Endoscopic band ligation combined with sclerotherapy has been postulated to be superior to ligation alone for the treatment of esophageal variceal bleeding.
Methods: A randomized trial of ligation versus combined ligation and sclerotherapy was designed to determine whether combined therapy results in faster eradication of varices compared to ligation alone. Sixty patients were randomized to undergo band ligation or ligation combined with injection of 1 to 2 mL of polidocanol (1%) into each variceal column immediately proximal to the previously placed bands. Therapy was repeated at 1- or 2-week intervals until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months and then at 6-month intervals.
Results: The demographic and clinical characteristics of the 31 patients who underwent ligation were similar to those of the 29 who received combined treatment. Sixty percent of the patients had cirrhosis due to viral hepatitis. No significant differences were found between the combined and ligation alone groups in arresting active bleeding [9 of 9 (100%) vs. 6 of 7 (86%)], units of blood transfusion (3 ± 0.8 vs. 2 ± 0.6), number of sessions required to eradicate varices (3.8 ± 0.5 vs. 3.6 ± 0.4), treatment failure [2 (17%) vs. 4 (14%)], esophageal varice recurrence [6 (21.%) vs. 2 (6%)], gastric varices formation [4 (14%) vs. 1 (3%)], stricture [1 (3%) vs. 0 (0%)], recurrent bleeding [5 (17%) vs. 7 (23%)], other complications [10 (34%) vs. 9 (29%)], or death [3 (10%) vs. 7 (23%)] during a follow-up period of up to 36 months.
Conclusions: Combined ligation and sclerotherapy does not reduce the number of endoscopic treatment sessions required for variceal eradication and offers no benefit over ligation alone. Because of the lack of benefit, the added procedure time, and the cost, we do not advocate combination therapy, and ligation alone remains the best endoscopic treatment. (Gastrointest Endosc 1999;50:1-6.) |
| doi_str_mv | 10.1016/S0016-5107(99)70335-4 |
| format | Article |
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Methods: A randomized trial of ligation versus combined ligation and sclerotherapy was designed to determine whether combined therapy results in faster eradication of varices compared to ligation alone. Sixty patients were randomized to undergo band ligation or ligation combined with injection of 1 to 2 mL of polidocanol (1%) into each variceal column immediately proximal to the previously placed bands. Therapy was repeated at 1- or 2-week intervals until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months and then at 6-month intervals.
Results: The demographic and clinical characteristics of the 31 patients who underwent ligation were similar to those of the 29 who received combined treatment. Sixty percent of the patients had cirrhosis due to viral hepatitis. No significant differences were found between the combined and ligation alone groups in arresting active bleeding [9 of 9 (100%) vs. 6 of 7 (86%)], units of blood transfusion (3 ± 0.8 vs. 2 ± 0.6), number of sessions required to eradicate varices (3.8 ± 0.5 vs. 3.6 ± 0.4), treatment failure [2 (17%) vs. 4 (14%)], esophageal varice recurrence [6 (21.%) vs. 2 (6%)], gastric varices formation [4 (14%) vs. 1 (3%)], stricture [1 (3%) vs. 0 (0%)], recurrent bleeding [5 (17%) vs. 7 (23%)], other complications [10 (34%) vs. 9 (29%)], or death [3 (10%) vs. 7 (23%)] during a follow-up period of up to 36 months.
Conclusions: Combined ligation and sclerotherapy does not reduce the number of endoscopic treatment sessions required for variceal eradication and offers no benefit over ligation alone. Because of the lack of benefit, the added procedure time, and the cost, we do not advocate combination therapy, and ligation alone remains the best endoscopic treatment. (Gastrointest Endosc 1999;50:1-6.)</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/S0016-5107(99)70335-4</identifier><identifier>PMID: 10385713</identifier><identifier>CODEN: GAENBQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Combined Modality Therapy ; Diseases of the digestive system ; Endoscopy - methods ; Esophageal and Gastric Varices - complications ; Esophageal and Gastric Varices - mortality ; Esophageal and Gastric Varices - therapy ; Esophagoscopy ; Esophagus ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Gastrointestinal Hemorrhage - etiology ; Gastrointestinal Hemorrhage - mortality ; Gastrointestinal Hemorrhage - therapy ; Humans ; Ligation - instrumentation ; Ligation - methods ; Liver Transplantation ; Male ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Polidocanol ; Polyethylene Glycols - administration & dosage ; Postoperative Complications - epidemiology ; Prospective Studies ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Recurrence ; Sclerosing Solutions - administration & dosage ; Sclerotherapy - methods ; Treatment Outcome</subject><ispartof>Gastrointestinal endoscopy, 1999-07, Vol.50 (1), p.1-6</ispartof><rights>1999 American Society for Gastrointestinal Endoscopy</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-37898e5b3f91d41b3e37a940e668d7fd76f08056cdd7af86fca797bb91f3ceeb3</citedby><cites>FETCH-LOGICAL-c456t-37898e5b3f91d41b3e37a940e668d7fd76f08056cdd7af86fca797bb91f3ceeb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0016-5107(99)70335-4$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,46004</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1917120$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10385713$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Al Traif, Ibrahim</creatorcontrib><creatorcontrib>Fachartz, Fayiz Sbeih</creatorcontrib><creatorcontrib>Al Jumah, Abdulrahman</creatorcontrib><creatorcontrib>Al Johani, Mishall</creatorcontrib><creatorcontrib>Al Omair, Ahmed</creatorcontrib><creatorcontrib>Al Bakr, Fahad</creatorcontrib><creatorcontrib>Al Knawy, Bandar</creatorcontrib><creatorcontrib>El Hafi, Ahmed</creatorcontrib><creatorcontrib>Khan, Mohammed H.</creatorcontrib><title>Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background: Endoscopic band ligation combined with sclerotherapy has been postulated to be superior to ligation alone for the treatment of esophageal variceal bleeding.
Methods: A randomized trial of ligation versus combined ligation and sclerotherapy was designed to determine whether combined therapy results in faster eradication of varices compared to ligation alone. Sixty patients were randomized to undergo band ligation or ligation combined with injection of 1 to 2 mL of polidocanol (1%) into each variceal column immediately proximal to the previously placed bands. Therapy was repeated at 1- or 2-week intervals until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months and then at 6-month intervals.
Results: The demographic and clinical characteristics of the 31 patients who underwent ligation were similar to those of the 29 who received combined treatment. Sixty percent of the patients had cirrhosis due to viral hepatitis. No significant differences were found between the combined and ligation alone groups in arresting active bleeding [9 of 9 (100%) vs. 6 of 7 (86%)], units of blood transfusion (3 ± 0.8 vs. 2 ± 0.6), number of sessions required to eradicate varices (3.8 ± 0.5 vs. 3.6 ± 0.4), treatment failure [2 (17%) vs. 4 (14%)], esophageal varice recurrence [6 (21.%) vs. 2 (6%)], gastric varices formation [4 (14%) vs. 1 (3%)], stricture [1 (3%) vs. 0 (0%)], recurrent bleeding [5 (17%) vs. 7 (23%)], other complications [10 (34%) vs. 9 (29%)], or death [3 (10%) vs. 7 (23%)] during a follow-up period of up to 36 months.
Conclusions: Combined ligation and sclerotherapy does not reduce the number of endoscopic treatment sessions required for variceal eradication and offers no benefit over ligation alone. Because of the lack of benefit, the added procedure time, and the cost, we do not advocate combination therapy, and ligation alone remains the best endoscopic treatment. (Gastrointest Endosc 1999;50:1-6.)</description><subject>Biological and medical sciences</subject><subject>Combined Modality Therapy</subject><subject>Diseases of the digestive system</subject><subject>Endoscopy - methods</subject><subject>Esophageal and Gastric Varices - complications</subject><subject>Esophageal and Gastric Varices - mortality</subject><subject>Esophageal and Gastric Varices - therapy</subject><subject>Esophagoscopy</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Gastrointestinal Hemorrhage - therapy</subject><subject>Humans</subject><subject>Ligation - instrumentation</subject><subject>Ligation - methods</subject><subject>Liver Transplantation</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Polidocanol</subject><subject>Polyethylene Glycols - administration & dosage</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prospective Studies</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Recurrence</subject><subject>Sclerosing Solutions - administration & dosage</subject><subject>Sclerotherapy - methods</subject><subject>Treatment Outcome</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1LxDAQhoMoun78BCUHET1UE9MmzUlE_IIFwY9zSJPJGmmbNeku6K837i7qzcvMYZ53ZngQ2qfklBLKz55IrkVFiTiW8kQQxqqiXEMjSqQouBByHY1-kC20ndIbIaQ-Z3QTbVHC6kpQNkKTR93b0PlPsHiIXrc4ONz6iR586PEcYpolbELX-D4TP4Mcwsm0EMPwClFPP7ALETctgPX9BEMK01c9gbxurqM3kHbRhtNtgr1V30EvN9fPV3fF-OH2_upyXJiy4kPBRC1rqBrmJLUlbRgwoWVJgPPaCmcFd6QmFTfWCu1q7owWUjSNpI4ZgIbtoKPl3mkM7zNIg-p8MtC2uocwS4rLumKspBmslqCJIaUITk2j73T8UJSob8NqYVh961NSqoVhVebcwerArOnA_kktlWbgcAXoZHTrou6NT7-cpIKek4xdLDHINuYeokrGQ2-ywAhmUDb4fz75AmZvmgU</recordid><startdate>19990701</startdate><enddate>19990701</enddate><creator>Al Traif, Ibrahim</creator><creator>Fachartz, Fayiz Sbeih</creator><creator>Al Jumah, Abdulrahman</creator><creator>Al Johani, Mishall</creator><creator>Al Omair, Ahmed</creator><creator>Al Bakr, Fahad</creator><creator>Al Knawy, Bandar</creator><creator>El Hafi, Ahmed</creator><creator>Khan, Mohammed H.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990701</creationdate><title>Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices</title><author>Al Traif, Ibrahim ; Fachartz, Fayiz Sbeih ; Al Jumah, Abdulrahman ; Al Johani, Mishall ; Al Omair, Ahmed ; Al Bakr, Fahad ; Al Knawy, Bandar ; El Hafi, Ahmed ; Khan, Mohammed H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-37898e5b3f91d41b3e37a940e668d7fd76f08056cdd7af86fca797bb91f3ceeb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Biological and medical sciences</topic><topic>Combined Modality Therapy</topic><topic>Diseases of the digestive system</topic><topic>Endoscopy - methods</topic><topic>Esophageal and Gastric Varices - complications</topic><topic>Esophageal and Gastric Varices - mortality</topic><topic>Esophageal and Gastric Varices - therapy</topic><topic>Esophagoscopy</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Gastrointestinal Hemorrhage - therapy</topic><topic>Humans</topic><topic>Ligation - instrumentation</topic><topic>Ligation - methods</topic><topic>Liver Transplantation</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Polidocanol</topic><topic>Polyethylene Glycols - administration & dosage</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prospective Studies</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Recurrence</topic><topic>Sclerosing Solutions - administration & dosage</topic><topic>Sclerotherapy - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Al Traif, Ibrahim</creatorcontrib><creatorcontrib>Fachartz, Fayiz Sbeih</creatorcontrib><creatorcontrib>Al Jumah, Abdulrahman</creatorcontrib><creatorcontrib>Al Johani, Mishall</creatorcontrib><creatorcontrib>Al Omair, Ahmed</creatorcontrib><creatorcontrib>Al Bakr, Fahad</creatorcontrib><creatorcontrib>Al Knawy, Bandar</creatorcontrib><creatorcontrib>El Hafi, Ahmed</creatorcontrib><creatorcontrib>Khan, Mohammed H.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Al Traif, Ibrahim</au><au>Fachartz, Fayiz Sbeih</au><au>Al Jumah, Abdulrahman</au><au>Al Johani, Mishall</au><au>Al Omair, Ahmed</au><au>Al Bakr, Fahad</au><au>Al Knawy, Bandar</au><au>El Hafi, Ahmed</au><au>Khan, Mohammed H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>1999-07-01</date><risdate>1999</risdate><volume>50</volume><issue>1</issue><spage>1</spage><epage>6</epage><pages>1-6</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><coden>GAENBQ</coden><abstract>Background: Endoscopic band ligation combined with sclerotherapy has been postulated to be superior to ligation alone for the treatment of esophageal variceal bleeding.
Methods: A randomized trial of ligation versus combined ligation and sclerotherapy was designed to determine whether combined therapy results in faster eradication of varices compared to ligation alone. Sixty patients were randomized to undergo band ligation or ligation combined with injection of 1 to 2 mL of polidocanol (1%) into each variceal column immediately proximal to the previously placed bands. Therapy was repeated at 1- or 2-week intervals until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months and then at 6-month intervals.
Results: The demographic and clinical characteristics of the 31 patients who underwent ligation were similar to those of the 29 who received combined treatment. Sixty percent of the patients had cirrhosis due to viral hepatitis. No significant differences were found between the combined and ligation alone groups in arresting active bleeding [9 of 9 (100%) vs. 6 of 7 (86%)], units of blood transfusion (3 ± 0.8 vs. 2 ± 0.6), number of sessions required to eradicate varices (3.8 ± 0.5 vs. 3.6 ± 0.4), treatment failure [2 (17%) vs. 4 (14%)], esophageal varice recurrence [6 (21.%) vs. 2 (6%)], gastric varices formation [4 (14%) vs. 1 (3%)], stricture [1 (3%) vs. 0 (0%)], recurrent bleeding [5 (17%) vs. 7 (23%)], other complications [10 (34%) vs. 9 (29%)], or death [3 (10%) vs. 7 (23%)] during a follow-up period of up to 36 months.
Conclusions: Combined ligation and sclerotherapy does not reduce the number of endoscopic treatment sessions required for variceal eradication and offers no benefit over ligation alone. Because of the lack of benefit, the added procedure time, and the cost, we do not advocate combination therapy, and ligation alone remains the best endoscopic treatment. (Gastrointest Endosc 1999;50:1-6.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>10385713</pmid><doi>10.1016/S0016-5107(99)70335-4</doi><tpages>6</tpages></addata></record> |
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| subjects | Biological and medical sciences Combined Modality Therapy Diseases of the digestive system Endoscopy - methods Esophageal and Gastric Varices - complications Esophageal and Gastric Varices - mortality Esophageal and Gastric Varices - therapy Esophagoscopy Esophagus Female Gastroenterology. Liver. Pancreas. Abdomen Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - mortality Gastrointestinal Hemorrhage - therapy Humans Ligation - instrumentation Ligation - methods Liver Transplantation Male Medical sciences Middle Aged Other diseases. Semiology Polidocanol Polyethylene Glycols - administration & dosage Postoperative Complications - epidemiology Prospective Studies Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Recurrence Sclerosing Solutions - administration & dosage Sclerotherapy - methods Treatment Outcome |
| title | Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices |
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