Comparative prospective study of various endoscopic treatments for different grades of esophageal variceal bleeding in upper Egypt

Abstract EN

This study was performed on 120 patients presented with liver cirrhosis and active variceal bleeding in the form of hematemesis or melena or both in Assuit University Hospital.

They were 79 male and 41 female aging from 25-70 years.

All patients were chosen to be Child-Pugh class B.

All patients included in this study were subjected to upper gastrointestinal endoscopy, and one of the following was done to the bleeding esophageal varices: Sclerotherapy with Ethanolamine (Group A), Sclerother-apy with Histoacryl (Group B), Band ligation, (Group C) and combined scleroligation (Group D) and the varices are classified according to Westaby classification 1982 into grade I, II, III and IV.

We also follow up endoscopy until obliteration of varices was achieved.

The present study was undertaken to compare the different endosco-pic techniques used in active esophageal variceal bleeding, and its efficacy in controlling bleeding from the varices, the rate of rebleeding, the number of sessions done to obliterate the varices, and the complication in the form of esophageal ulceration.

From this study, it was suggested that the choice of endoscopic technique used for management of bleeding esophageal varices depends on the grade of varices as follow: In Grade II esophageal varices with active bleeding, there was no method of choice, but it is better to start with Ethanolamine injection for control of bleeding (because it is available easy and cheap technique).

If failed so Histoacryl injection should be the second choice.

In Grades III and IV esophageal varices with active bleeding, it is better to start with band ligation for the control of bleeding, it is the method of choice, as it has better control of bleeding, the least number of sessions, the least rebleeding rate, with no complications and the easiest method of treatment.

We also found histoacryl injection although it is the best method of controlling bleeding, it is better to use it only if the other methods are not effective, as it is a very expensive method and used only in the first session or in rebleeding.It is hazardous in small varices if not cautiously administered and we also found that scleroligation did not add any benefit over band ligation but more adverse effects and complications were noticed.

In conclusion, band ligation was the method of choice for esophageal variceal obliteration among all the other endoscopic techniques as regard all the variables collectively, also we could decrease the cost of band ligation to a minimum degree.