Randomized controlled trial comparing endoscopic ligation with or without sclerotherapy for secondary prophylaxis of variceal bleeding
| Autor: | Xiao-qing Zeng, Hong Gao, Yujen Tseng, Jie Chen, Tian-cheng Luo, Lili Ma, Bing Li, Jingjing Lian, Shiyao Chen, Jian Wang |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Polidocanol Esophageal and Gastric Varices Gastroenterology Polyethylene Glycols law.invention 03 medical and health sciences 0302 clinical medicine Esophageal varices Randomized controlled trial Recurrence law Internal medicine Sclerotherapy Humans Medicine Cyanoacrylates Ligation Survival rate Aged Hepatology business.industry Sclerosing Solutions Middle Aged Gastric varices medicine.disease Combined Modality Therapy Surgery Survival Rate 030220 oncology & carcinogenesis Concomitant Female 030211 gastroenterology & hepatology Esophagoscopy Gastrointestinal Hemorrhage business |
| Zdroj: | European Journal of Gastroenterology & Hepatology. 28:95-100 |
| ISSN: | 0954-691X |
| Popis: | Objectives A recently published network meta-analysis showed that ligation combined with sclerotherapy might be the most efficacious intervention for secondary prophylaxis of variceal bleeding. Most studies excluded patients with concomitant gastric varices; thus, the outcomes in such patients have not yet been reported. The present study aimed to investigate the efficacy of two endoscopic procedures for secondary prophylaxis in cirrhotic patients presenting with both esophageal and gastric varices. Materials and methods A randomized controlled study was carried out in a tertiary care referral center. Patients were randomized into two groups: sclerotherapy- and sclerotherapy+ group. Continued endoscopic ligation was used to treat esophageal varices in the sclerotherapy- group, whereas combined ligation and sclerotherapy with lauromacrogol was performed in the sclerotherapy+ group. A cyanoacrylate injection was used for gastric varices in both groups. All participants were followed up for 6 months. Results Overall, 96 patients were included between 25 March 2012 and 25 June 2013. Three patients were lost during follow-up (one in the sclerotherapy- group and two in the sclerotherapy+ group). The cumulative recurrence rate of bleeding was significantly higher in the sclerotherapy+ group (14.6 vs. 35.4%, P=0.013). The cumulative mortality rate (2.1 vs. 6.3%, P=0.286) and the incidence rate of adverse events were similar between the two groups. Conclusion Continued ligation+cyanoacrylate injection was superior to combined ligation and sclerotherapy+cyanoacrylate injection during the first 6 months in terms of rebleeding in cirrhotic patients presenting with both esophageal and gastric varices. Long-term results entail further investigation (http://www.clinicaltrials.gov, NCT01592578). |
| Databáze: | OpenAIRE |
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