Advertisement

Acta Endoscopica

, 25:365 | Cite as

Ligature endoscopique dans le traitement des varices œsophagiennes et du cardia

  • M. Jung
  • A. Zipf
Article

Conclusion

La ligature endoscopique des varices œsophagiennes est une technique efficace du traitement des varices hémorragiques. L’apprentissage de la méthode est facile, sa manipulation est simple et elle entraîne beaucoup moins de complications que la sclérothérapie conventionnelle. Certains désavantages résultent d’une visibilité limitée à l’intérieur de l’adaptateur et, si l’on se prive du tube gaine, du fait qu’il faut accepter la nécessité d’introduire et de retirer de façons répétées l’instrument pour le recharger de petits anneaux circulaires de caoutchouc. L’expérience relative aux complications liées à l’emploi du tube gaine montre qu’il faut autant que possible en limiter l’usage. La ligature endoscopique entraîne une éradication rapide des varices et réduit probablement le risque de récidive hémorragique. Les résultats des diverses études randomisées ne permettent pas jusqu’à présent de démontrer l’efficacité et la sécurité de la méthode, elles indiquent seulement une tendance à préférer la méthode du traitement par ligature.

Il reste à confirmer par des études plus récentes, les résultats initialement optimistes relatifs au long terme qui avaient été fournis par l’étude américaine. Ce n’est pas encore le cas actuellement et il n’est pas possible de parler du remplacement de la sclérothérapie conventionnelle.

Mots-clés

ligature endoscopique varices du cardia varices œsophagiennes 

Endoscopic ligation for the treatment of esophageal and cardiac varices

Conclusion

Endoscopic variceal ligation is an effective method for treatment of bleeding esophageal varices. The procedure is easy to learn, its handling is simple and it causes fewer complications than conventional sclerotherapy. Some disadvantages are the limited visibility through the loaded adapter and, if omitting the overtube, the fact that the endoscope has to be repeatedly inserted and withdrawn to load new rubber bands. The experience gained with regard to the complications caused by the overtube indicate that its use should be limited. Endoscopic ligation produces rapid eradication of varices and can probably reduce the risk of rebleeding. The divergent results of randomized studies do not yet permit a final statement on the efficacy and safety of this method, but only indicate a trend towards ligation becoming the preferred treatment.

It remains to be seen whether the initially optimistic long-term results from the American study will also be confirmed by more recent reports. Not until this is the case will it be possible to speak of a replacement for conventional sclerotherapy.

Key-words

esophageal varices cardiac varices endoscopic ligation therapy 

Références

  1. 1.
    BARSOUM M., MOORO H., BOLOUS F., RAMZY A., RIZK-ALLAH M., MAHMOUD F. — The complications of injection sclerotherapy of bleeding esophageal varices.Br. J. Surg., 1982,69, 79–81.PubMedCrossRefGoogle Scholar
  2. 2.
    BERKELHAMMER C., MADHAV G., LYON S., ROBERTS J. — «Pinch» injury during overtube placement in upper endoscopy.Gastrointest. Endosc., 1993, 186–188.Google Scholar
  3. 3.
    BRETAGNE J.F., RAOUL J.L., GASTARD J. — Méta-analyse des essais randomisés et contrôlés (ERC) de la sclérose endoscopique (SE).Gastroenterol. Clin. Biol., 1989,13, 1018 AGoogle Scholar
  4. 4.
    BURROUGHS A.K., MORABITO A., DE FRANCHIS R., BOSCH J., FRANCO D., AKRIVIADIS E. — Working Team Report: Treatment of acute oesophageal variceal bleeding — a metaanalytic study. First United European Gastroenterology Week 1992, Athens, Greece, 26. September 1992.Google Scholar
  5. 5.
    CLARK A., WESTABY D., SILK D., DAWSON J., MAC DOUGALL B., MITCHELL K., STRUNIN L., WILLIAMS R. — Prospective controlled trial of injection sclerotherapy in patients with cirrhosis and recent variceal haemorrhage.Lancet II, 1980, 552–554.Google Scholar
  6. 6.
    DUMAS O., BOUSTIÈRE C., LETARD J.C., DEPLAIX P., ETAIX J.P., PATOUILLARD B., BARTHÉLÉMY C., AUDIGIER J.C. — Effect of endoscopic injection sclerotherapy on gastric varices and portal hypertensive gastropathy: endoscopic ultrasonography data.Gastroenterology, 1994,106, A-16.Google Scholar
  7. 7.
    FLEIG W., STANGE E., HUNECKE R., SCHÖNBORN W., HURLER U., RAINER K., GAUS W., DITSCHUNEIT H. — Prevention of recurrent bleeding in cirrhotics with recent variceal hemorrhage: prospective, randomized comparison of propranolol and sclerotherapy.Hepatology, 1987,7, 355–361.PubMedCrossRefGoogle Scholar
  8. 8.
    GOLDSCHMIEDT M., HABER G., KANDEL G. — A safety maneuver for placing overtubes during endoscopic variceal ligation.Gastrointest. Endosc., 1992,38, 399–400.PubMedGoogle Scholar
  9. 9.
    GIMSON A.E.S., RAMAGE J.K., PANOS M.Z., HAYLLAR K., HARRISON P.M., WILLIAMS R., WESTABY D. — Randomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices.Lancet, 1993,342, 391–394.PubMedCrossRefGoogle Scholar
  10. 10.
    GOFF J.S., REVEILLE R.M., STIEGMANN G.V. — Three-year experience with endoscopic variceal ligation for treatment of bleeding varices.Endoscopy, 1992,24, 401–404.PubMedGoogle Scholar
  11. 11.
    HAMM B., ALTENÄHR E. — Morphologische Befunde am distalen Ösophagus nach Sklerosierung blutender Varizen.Dtsch. med. Wschr., 1982,107, 293–298.PubMedGoogle Scholar
  12. 12.
    HASHIZUME M., OHTA M., UENO K., TANOUE K., KITANO S., SUGIMACHI K. — Endoscopic ligation of esophageal varices compared with injection sclerotherapy: a prospective randomized trial.Gastrointest. Endosc., 1993,39, 123–126.PubMedGoogle Scholar
  13. 13.
    INFANTE-RIVARD C., ESNAOLA S., VILLENEUVE J.P. — Role of Endoscopic Variceal Sclerotherapy in the Long-Term Management of Variceal Bleeding: A Meta-analysis.Gastroenterology, 1989,96, 1087–1092.PubMedGoogle Scholar
  14. 14.
    JOHNSON P.A., CAMPBELL D.R., ANTONSON C.W., WESTON A.P., SHULER F.N., LOZOFF R.D. — Complications associated with endoscopic band ligation of esophageal varices.Gastrointest. Endosc., 1993,39, 181–185.PubMedGoogle Scholar
  15. 15.
    JENSEN D.M., KOVACS T.O.G., RANDALL G., JUTABHA R., FREEMAN M., CHENG S., JENSEN M.E., PELAYO E., HSIEH S., GORNBEIN J. — Emergency sclerotherapy vs. rubber band ligation for actively bleeding esophagogastric varices in a randomized prospective study.Gastrointest. Endosc., 1994,40, A 244.Google Scholar
  16. 16.
    LAINE L., EL-NEWIHI H.M., MIGIKOVSKY B., SLOANE R., GARCIA F. — Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices.Ann. Intern. Med., 1993,119, 1–7.PubMedGoogle Scholar
  17. 17.
    LAINE L., COOK D. — Endoscopic ligation vs. sclerotherapy for esophageal variceal bleeding: a meta-analysis.Gastrointest. Endosc., 1994,40, A 249.Google Scholar
  18. 18.
    LARSON A., COHEN H., ZWEIBAN B., CHAPMAN D., GOURDJI M., KORULA J., WEINER J. — Acute esophageal variceal sclerotherapy. Results of a prospective randomized controlled trial.JAMA, 1986,255, 497–500.PubMedCrossRefGoogle Scholar
  19. 19.
    LO G.H., LAI K.H., NG W.W., TAM T.N., LEE S.D., TSAI Y.T., LO K.J. — Injection sclerotherapy preceded by esophageal tamponade versus immediate sclerotherapy in arresting active variceal bleeding: a prospective randomized trial.Gastrointest. Endosc., 1992,38, 421–424.PubMedGoogle Scholar
  20. 20.
    LO G.H., LAI K.H., SHEN M.T., CHANG C.F. — A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices.Gastrointest. Endosc., 1994,40, 675–679.PubMedGoogle Scholar
  21. 21.
    LO G.H., LIANG H.L., LAI K.H., CHANG C.F., HU C.H., CHEN S.M., LIN J.K., CHIANG H.T. — The impact of endoscopic variceal ligation on the pressure of portal system.Gastrointest. Endosc., 1994,40, A 72.Google Scholar
  22. 22.
    MAC DOUGALL B., THEODOSSI A., WESTABY D., DAWSON J.L. — Increased long-term survival in variceal Haemorrhage using injection sclerotherapy. Results of a Controlled Trial.Lancet I, 1982, 124–127.CrossRefGoogle Scholar
  23. 23.
    MATHUR S.K., VORA I.M., SUPE A.N. u. Mitarb. — Morphological changes in the oesophagus following variceal sclerotherapy with 3 % phenol.Ind. J. Gastroenterol., 1990,9, 213–215.Google Scholar
  24. 24.
    MITCHELL K.J., MAC DOUGALL B.R.D., SILK D.B.A., WILLIAMS R. — A prospective reappraisal of emergency endoscopy in patients with portal hypertension.Scand. J. Gastroenterol., 1982,17, 965–968.PubMedGoogle Scholar
  25. 25.
    PAQUET K.-J., FEUSSNER H. — Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: A prospective controlled randomized trial.Hepatology, 1985,5, 580–583.PubMedCrossRefGoogle Scholar
  26. 26.
    SALTZMAN J.R., ARORA S. — Complications of esophageal variceal band ligation.Gastrointest. Endosc., 1993,39, 185–186.PubMedCrossRefGoogle Scholar
  27. 27.
    SARIN S.K., NANDA R., VIJ J.C., u. Mitarb. — Esophageal ulcerations after endoscopic sclerotherapy: A complication or an accompainment?Endoscopy, 1986,18, 44–45.PubMedGoogle Scholar
  28. 28.
    SARIN S.K., KUMAR A. — Sclerosants for Variceal Sclerotherapy: A Critical Appraisal.Amer. J. Gastroent., 1990,85, 641–648PubMedGoogle Scholar
  29. 29.
    SCHOONBROODT D., ZIPF A., JUNG M. — Local necrosis and fatal perforation of oesophagus after endoscopic ligation.Lancet, 1994, 344, 1365.PubMedCrossRefGoogle Scholar
  30. 30.
    SOEHENDRA N., GRIMM H., DE HEER K. — Fiberendoskopische Verödungstherapie bei der akuten Oesophagusvarizenblutung.Verdauungskrankheiten, 1984,2, 6–10.Google Scholar
  31. 31.
    SOEHENDRA N., NAM V.C., GRIMM H., KEMPENEERS I. — Endoscopic obliteration of large esophagogastric varices with Bucrylate.Endoscopy, 1986,18, 25–26.PubMedGoogle Scholar
  32. 32.
    STIEGMANN G.V., GOFF J.S., HAMMOND W. — Results of experimental endoscopic esophageal variceal ligation.Am. Surg., 1988,54, 105–108.PubMedGoogle Scholar
  33. 33.
    STIEGMANN G.V., GOFF J.S., SUN J.H., HRUZA D., REVEILLE R.M. — Endoscopic Ligation of Esophageal Varices.Am. J. Surgery, 1990,159, 21–26.CrossRefGoogle Scholar
  34. 34.
    STIEGMANN G.V., GOFF J.S., MICHALETZ-ONODY P.A., KORULA J., LIEBERMAN D., SAEED Z.A., REVEILLE R.M., SUN J.H., LOWENSTEIN S.R. — Endoscopic Sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.N. Engl. J. Med., 1992,326, 1527–1532PubMedGoogle Scholar
  35. 35.
    STIEGMANN G.V. — Endoscopic ligation: now and the future.Gastrointest. Endosc., 1993,39, 203–205.PubMedGoogle Scholar
  36. 36.
    TERBLANCHE J., KAHN D., CAMPBELL J.A.H., BORNMAN P.C., JONKER M.A.T., WRIGHT J., KIRSCH R. — Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. A Five-year Prospective Controlled Clinical Trial.Lancet II. 1983, 1328–1332.Google Scholar
  37. 37.
    TERBLANCHE J., BURROUGHS A.K., HOBBS K.E.F. — Controversies in the management of bleeding esophageal varices.N. Engl. J. Med., 1989,21, 1393–1399.Google Scholar
  38. 38.
    WESTABY D., HAYES P.C., GIMSON A.E.S., POLSON R.J., WILLIAMS R. — Controlled Clinical Trial of Injection Sclerotherapy for Active Variceal Bleeding.Hepatology, 1989,9, 271–277CrossRefGoogle Scholar
  39. 39.
    YOUNG M.F., SANOWSKI R.A., RASCHE R. — Comparison and characterization of ulcerations induced by endoscopic ligation of esophageal varices versus endoscopic sclerotherapy.Gastrointest. Endosc., 1993,39, 119–122.PubMedCrossRefGoogle Scholar
  40. 40.
    ZAMBELLI A., AND THE NEW ITALIAN ENDOSCOPIC CLUB — Complications of endoscopic sclerotherapy of esophageal varices.Giorn. It. End. Dig., 1991,14, 103–119Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • M. Jung
    • 1
  • A. Zipf
    • 2
  1. 1.St Hildegardis-KrankenhausMainzAllemagne
  2. 2.Johan Wolfgang Goethe University HospitalFrankfurt am MainAllemagne

Personalised recommendations