Long term efficacy of endoscopic ligation plus cyanoacrylate injection for variceal bleeding: with or without sclerotherapy

Abstract

Objective

The prognosis of cirrhotic patients with concurrent esophageal and gastric varices have not been reported. We evaluated the long term outcomes and efficacy of continued ligation plus cyanoacrylate vs. combined ligation and sclerotherapy plus cyanoacrylate for secondary prophylaxis in cirrhotic patients with concomitant esophageal and gastric varices.

Material and Methods

A retrospective cohort study was conducted. Patients were classified into two groups: continued ligation plus cyanoacrylate injection group (the sclerotherapy- group) and a combined ligation and sclerotherapy plus cyanoacrylate injection group (the sclerotherapy + group). Kaplan-Meier survival analysis was conducted and a log-rank test was used to compare the differences between the groups.

Results

125 patients were enrolled between April 1, 2004 and December 31, 2012. After a median follow up of 23.4 months, no significant difference was observed between the two groups in regards to variceal rebleed(29.7% vs 47.5%, P = 0.097) and mortality (12.5% vs 14.7%, P = 0.879). Among patients with ascites, cumulative rebleeding rate was significantly lower in the sclerotherapy- group (26.3% vs 59.4%, P = 0.020). A relapse of bleeding after the initial endoscopic therapy was an independent prognostic factor of bleeding relapse (P = 0.004). Portal thrombosis was an independent prognostic factor for mortality (P = 0.044).

Conclusions

No superiority of combined ligation and sclerotherapy was observed in this study compared to continued ligation and cyanoacrylate injection for secondary prophylaxis.

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