The role of endoscopic ligation in the management of esophageal varices and rupture
Solt, J.; Bajor, J.; Anga, B.
Orvosi Hetilap 140(44): 2445-2451
1999
ISSN/ISBN: 0030-6002 PMID: 10573988 Document Number: 503296
In the last two decades sclerotherapy has became one of the most widespread procedures in the palliative therapy of esophageal varicosity and rupture. Beside many of its advantages, there are high numbers of local and general complications. The new ligation method is very effective, but less invasive and free from side effects. The single shot method in spite of using overtube is slower, unpleasant and not free from risks. The new six shooter system, which uses 6 rubber-bands eliminates these disadvantages. This technique was introduced the first time in Hungary by the authors. They performed ligations between June 1997 and June 1999 on 39 random patients, 55 times. 41 times due to rupture of varices, 8 times in no-bleeding periods for eradication of varices, 6 times for prophylaxis. The average age was 51 (27-75), 32 men and 7 women participating. The cause of esophageal varicosity was thrombosis of vena portae in 1 patient and cirrhosis in others. The background of the cirrhosis was alcohol in all cases except for one which was due to alcohol and hepatitis C in addition. Altogether 346 rubber-bands were applied. The average ligation was 6.3 (3-17) per patient and 4.5 (3-6) per session. The 41 ruptures of the 32 patients were treated with 80 units of blood, not including one patient given 29 units of blood who had mortal haemorrhage. It means 2.5 units of blood per patient and 2 units per varix rupture. After ligation patients had no complaints except for retrosternal discomfort in some patients. There were no complications observed. The mortality rate was 5 out of 32 one patient died due to bleeding. The follow up of the ligation was carried out by endoscopy and in the 4 dead patients by pathological procedures. The ligation method which was applied by the authors is effective, faster and has less complications in varix irradications than sclerotherapy. The prophylactic therapy of high risk patients and other therapeutic indications can contribute to its wider utilization.