Endoscopic variceal ligation (EVL) is being used increasingly to treat esophageal varices because of its safety and simplicity and because no sclerosant is required. However, early recurrence of esophageal varices after this procedure has been reported.
We compared the efficacy and long-term results of EVL performed in three treatments using a total of 16 O-rings at two different intervals, namely, biweekly (once every 2 weeks: the conventional interval) and bimonthly (once every 2 months). In all patients except two (both in the biweekly group), the esophageal varices were completely eradicated. Overall rates of both variceal recurrence and additional treatment were higher in the biweekly group than in the bimonthly group (P < 0.001).
EVL performed bimonthly in three treatment sessions for esophageal varices yielded better results than the same treatment performed biweekly. Treatment at the longer interval yielded a higher total eradication rate, lower recurrence rate, and lower rate of required additional treatment. Repeat treatment of EVL is useful; therefore, three treatment sessions should be considered as one course. Bimonthly EVL (three times in 4 months) might become a standard treatment for esophageal varices.
This is a preview of subscription content, log in to check access.
Masumori K, Onda M, Tajiri T, et al. Modified endoscopic variceal ligation. Dig Endosc. 1995;7:165–70.CrossRefGoogle Scholar
Umehara M, Onda M, Tajiri T, Toba M, Yoshida H, Yamashita K. Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices: a prospective randomized study. Gastrointest Endosc. 1999;50:7–12.CrossRefGoogle Scholar
Tajiri T, Onda M, Yoshida H, et al. Endoscopic scleroligation is a superior new technique for preventing recurrence of esophageal varices. J Nippon Med Sch. 2002;69:160–4.CrossRefGoogle Scholar
Yoshida H, Onda M, Tajiri T, et al. Endoscopic injection sclerotherapy for the treatment of reccurent esophageal varices after esophageal transection. Dig Endosc. 2002;14:93–8.CrossRefGoogle Scholar
Yoshida H, Onda M, Tajiri T, et al. New techniques: combined endoscopic injection sclerotherapy and ligation for acute bleeding from gastric varices. Hepatogastroenterology. 2002;49:932–4.PubMedGoogle Scholar
Yoshida H, Mamada Y, Taniai N, et al. A randomized control trial of bi-monthly versus bi-weekly endoscopic variceal ligation of esophageal varices. Am J Gastroenterol. 2005;100:2005–9.CrossRefGoogle Scholar
Sarin SK, Govil A, Jain AK, et al. Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence. J Hepatol. 1997;26:826–32.CrossRefGoogle Scholar
Yoshida H, Tajiri T, Mamada Y, et al. Comparison of characteristics of recurrent esophageal varices after endoscopic ligation versus endoscopic ligation plus sclerotherapy. Hepatogastroenterology. 2004;51:457–61.PubMedGoogle Scholar
Hou MC, Lin HC, Kuo BI, Chen CH, Lee FY, Lee SD. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial. Hepatology. 1995;21:1517–22.PubMedPubMedCentralGoogle Scholar
Yoshida H, Mamada Y, Taniai N, et al. Interactions between anti-ulcer drugs and non-steroidal anti-inflammatory drugs in cirrhotic patients with bleeding esophagogastric varices. Hepatogastroenterology. 2009;56:1366–70.PubMedPubMedCentralGoogle Scholar
Takase Y, Shibuya S, Chikamori F, et al. Recurrence factors studied by percutaneous transhepatic portography before and after endoscopic sclerotherapy for esophageal varices. Hepatology. 1990;11:348–52.CrossRefGoogle Scholar
Matumoto H, Matsutani S, Fukuzawa T, et al. Hemodynamics in the left gastric vein after endoscopic ligation of esophageal varices combined with sclerotherapy. J Gastroenterol Hepatol. 2001;16:495–500.CrossRefGoogle Scholar
Lo GH, Liang HL, Lai KH, et al. The impact of endoscopic variceal ligation on the pressure of the portal venous system. J Hepatol. 1996;24:74–80.CrossRefGoogle Scholar
Kimura T, Moriyasu F, Kawasaki T, et al. Relationship between esophageal varices and azygos vein evaluated by cineportography. Hepatology. 1991;13:858–64.CrossRefGoogle Scholar