Ligation of Esophageal Varices with Elastic Bands in Cirrhotic Patients
Keywords:
liver cirrhosis, portal hypertension, esophageal varices, ligation with elastic bandsAbstract
Introduction: Elastic band ligation (EBL) has proven efficacy against bleeding from esophageal varices in cirrhotic patients, as well as in primary and secondary prophylaxis.
Objective: To describe the results of LBE of esophageal varices in cirrhotic patients.
Methods: A prospective study was carried out in 39 cirrhotic patients with grade III or IV esophageal varices (Paquet classification), who underwent elective or active bleeding consecutively, in Gastroenterology Service at Luc?a ??iguez Land?n Clinical Surgical Hospital, from December 2013 to March 2015.
Results: The mean age was 56.2 ? 13.2 years, with male predominance (69.2%). Alcoholism (35.9%) and virus C (33.3%) were the most common causes. Patients in Child Pugh B (48.7%) and C (46.2%) and those tied in the emergency room (46.2%) predominated. Previous endoscopic treatment was found in 30.8% and 71.8% required a single ligation session. Retrosternal pain was the most common complication (20.5%). Propranolol was used in 94.9% with mean dose of 40.5 ? 17.9 mg / day. At a mean follow-up of 9.96 ? 4.15 months, 15.6% rebled, associated to the recurrence of esophageal varices (p = 0.001) and history of portal hypertensive gastropathy (p = 0.003). Cumulative rebleeding free survival at 1, 6, and 9 months was 89.7%, 87.1%, and 84.4%, respectively. Overall mortality was 7.7%. Cumulative mortality-free survival at one, two, and three months was 97.4%, 94.9%, and 92.3%, respectively.
Conclusions: Ligation with elastic bands is an effective and safe procedure for the treatment of esophageal varices in cirrhotic patients in different clinical settings.
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