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Efficacy of Endoscopic Band Ligation in the Treatment of Acute Esophageal Varicose Bleeding

Yıl 2022, Cilt 12, Sayı 2, 223 - 227, 15.03.2022
https://doi.org/10.16899/jcm.1015238

Öz

Objective: To determine the efficacy of endoscopic band ligation (EBL) on rebleeding and mortality in the treatment of esophageal varices bleeding. Methods: Fifty cirrhosis patients who applied to the emergency department with acute esophageal variceal bleeding between 2018 and 2020 and were treated with EBL within the first 12 hours were evaluated retrospectively. Results: Twenty-seven (54%) patients were male and 23 (46%) were female. The mean hospital stay of the patients was 6.45.6 days, and the mean blood transfusion requirement was 3.62.7 units. Re-bleeding was observed within 30 days in 5 (10%) patients and within 1 year in 7 (14%) patients. Ten (20%) patients died within 30 days, and 11 (22%) patients died within 1 year. The need for blood transfusion was higher in patients with grade 3 varicose veins (4.93.1) than in patients with grade 2 varicose veins (2.51.5) (p=0.001). Mortality rate within 30 days and 1 year was significantly higher in patients with grade 3 varicose veins (p=0.001). Although the rate of bleeding within 30 days and 1 year was higher in patients with grade 3 varicose veins than in patients with grade 2 varices, the difference was not significant (p=0.087). Conclusion: EBL is an endoscopic treatment method to be preferred in patients with acute esophageal variceal hemorrhage due to its low risk of re-bleeding and low mortality rate.

Kaynakça

  • 1. Calès P, Pascal JP. [Natural history of esophageal varices in cirrhosis (from origin to rupture)]. Gastroenterol Clin Biol 1988;12:245-254
  • 2. Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010;362:823-832.
  • 3. Sauerbruch T, Wong F. Treatment of Oesophageal Varices in Liver Cirrhosis. Digestion 2019;99:261–266
  • 4. Cordon JP, Torres CF, García AB, Rodriguez FG, Suárez de Parga JM. Endoscopic management of esophageal varices. World J Gastrointest Endosc. 2012;4(7): 312-322
  • 5. Seo YS. Prevention and management of gastroesophageal varices. Clinical and Molecular Hepatology 2018;24:20-42.
  • 6. AASLD practice guidelines: Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46(3):922-938
  • 7. Fallah MA, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am 2000;84(5):1183–208
  • 8. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319: 983-989
  • 9. Merkel C, Zoli M, Siringo S, van Buuren H, Magalotti D, Angeli P, et al. Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenterol 2000; 95: 2915-2920
  • 10. Dai C, Liu W-X, Jiang M, Sun M-J. Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage: A meta-analysis. World J Gastroenterol. 2015 Feb 28; 21(8): 2534–2541.
  • 11. Lo GH, Lai KH, Cheng JS, Hwu JH, Chang CF, Chen SM, et al. A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology 1995;22:466-471.
  • 12. Stiegmann GV, Goff JS, Michaletz-Onody PA, Korula J, Lieberman D, Saeed ZA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med 1992;326:1527-1532.
  • 13. Salman AA, Shaaban HED, Atallah M, Yousef M, Ahmed RA, Ashoush O, et al. Long-term outcome after endoscopic ligation of acute esophageal variceal bleeding in patients with liver cirrhosis. Acta Gastro-Enterologica Belgica. 2020;83
  • 14. Albillos A, Tejedor M. Secondary prophylaxis for esophageal variceal bleeding. Clin. Liver Dis. 2014;18:359-370.
  • 15. Saeed ZA, Stiegmann GV, Ramirez FC, Reveille RM, Goff JS, Hepps KS, et al. Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices: a multicenter prospective randomized trial. Hepatol. Baltim. Md., 1997;25:71-74.
  • 16. Sempere L, Palazon JM, Sanchez-Paya J, PASCUAL Pascual S, De Madaria E, Poveda MJ, et al. Assessing the short and long-term prognosis of patients with cirrhosis and acute variceal bleeding. Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig. 2009;101:236-248.
  • 17. Garcia-Tsao G, Bosch J. Varices and Variceal Hemorrhage in Cirrhosis. A new view of an old problem. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2015;13:2109-2117.
  • 18. de Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol. 2015;63: 743–752.
  • 19. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922–938.
  • 20. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017;65:310-335.
  • 21. Yoo J-J, Chang Y, Cho EJ, Moon JE, Kim SG, Kim YS, et al. Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding. World J. Gastroenterol. 2018;24(44):5025–5033.
  • 22. Huh CW, Kim JS, Jung DH, Yang JD, Nam SW, Kwon JH, et al. Optimal endoscopy timing according to the severity of underlying liver disease in patients with acute variceal bleeding. Dig Liver Dis. 2019;51(7):993-998.
  • 23. Cheung J, Soo I, Bastiampillai R, Zhu Q, Ma M. Urgent vs. non-urgent endoscopy in stable acute variceal bleeding. Am J Gastroenterol. 2009;104(5):1125-9.
  • 24. Jung DH, Huh CW, Kim NJ, Kim B-W. Optimal endoscopy timing in patients with acute variceal bleeding: A systematic review and meta-analysis. Scientific Reports. 2020;10:4046
  • 25. Toshikuni N, Takuma Y, Tsutsumi M. Management of gastroesophageal varices in cirrhotic patients: current status and future directions. Annals of Hepatology. 2016;15 (3): 314-325
  • 26. Wells M, Chande N, Adams P, Beaton M, Levstik M, Boyce E, et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012;35:1267-1278.
  • 27. Bañares R, Albillos A, Rincón D, Alonso S, González M, Ruiz-del-Arbol L, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002;35:609-615.

Akut Özofagus Varis Kanama Tedavisinde Endoskopik Band Ligasyonunun Etkinliği

Yıl 2022, Cilt 12, Sayı 2, 223 - 227, 15.03.2022
https://doi.org/10.16899/jcm.1015238

Öz

Amaç: Özofagus varis kanama tedavisinde endoskopik band ligasyonunun (EBL) yeniden kanama ve mortalite üzerine etkiliğini belirlemek. Yöntemler: 2018-2020 yılları arasında acil servise akut özofagus varis kanaması ile başvuran ve ilk 12 saat içerisinde EBL tedavisi uygulanan 50 siroz hastası retrospektif olarak değerlendirildi. Bulgular: Hastaların 27’si (%54) erkek, 23’ü (%46) kadındı. Hastaların ortalama hastanede yatış süresi 6,45,6 gün, ortalama kan transfüzyon ihtiyacı 3,62,7 ünite idi. Beş (%10) hastada 30 gün içinde, 7(%14) hastada 1 yıl içinde tekrar kanama görüldü. On (%20) hasta 30 gün içinde, 11 (%22) hasta 1 yıl içinde öldü. Grade 3 varisli hastalarda (4,93,1) grade 2 varisli hastalara (2,51,5) göre kan transfüzyon ihtiyacı daha fazla idi(p=0,001). 30 gün ve 1 yıl içinde ölüm oranı grade 3 varisli hastalarda anlamlı olarak daha yüksekti (p=0,001). Otuz gün ve 1 yıl içinde kanama görülme oranı grade 3 varisli hastalarda grade 2 varisli hastalara göre daha yüksek olmakla birlikte fark anlamlı değildi (p=0,087). Sonuç: Akut özofagus varis kanama hastalarında EBL, tekrar kanama riskinin ve mortalite oranının az olması nedeniyle tercih edilecek bir endoskopik tedavi yöntemidir.

Kaynakça

  • 1. Calès P, Pascal JP. [Natural history of esophageal varices in cirrhosis (from origin to rupture)]. Gastroenterol Clin Biol 1988;12:245-254
  • 2. Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010;362:823-832.
  • 3. Sauerbruch T, Wong F. Treatment of Oesophageal Varices in Liver Cirrhosis. Digestion 2019;99:261–266
  • 4. Cordon JP, Torres CF, García AB, Rodriguez FG, Suárez de Parga JM. Endoscopic management of esophageal varices. World J Gastrointest Endosc. 2012;4(7): 312-322
  • 5. Seo YS. Prevention and management of gastroesophageal varices. Clinical and Molecular Hepatology 2018;24:20-42.
  • 6. AASLD practice guidelines: Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46(3):922-938
  • 7. Fallah MA, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am 2000;84(5):1183–208
  • 8. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319: 983-989
  • 9. Merkel C, Zoli M, Siringo S, van Buuren H, Magalotti D, Angeli P, et al. Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenterol 2000; 95: 2915-2920
  • 10. Dai C, Liu W-X, Jiang M, Sun M-J. Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage: A meta-analysis. World J Gastroenterol. 2015 Feb 28; 21(8): 2534–2541.
  • 11. Lo GH, Lai KH, Cheng JS, Hwu JH, Chang CF, Chen SM, et al. A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology 1995;22:466-471.
  • 12. Stiegmann GV, Goff JS, Michaletz-Onody PA, Korula J, Lieberman D, Saeed ZA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med 1992;326:1527-1532.
  • 13. Salman AA, Shaaban HED, Atallah M, Yousef M, Ahmed RA, Ashoush O, et al. Long-term outcome after endoscopic ligation of acute esophageal variceal bleeding in patients with liver cirrhosis. Acta Gastro-Enterologica Belgica. 2020;83
  • 14. Albillos A, Tejedor M. Secondary prophylaxis for esophageal variceal bleeding. Clin. Liver Dis. 2014;18:359-370.
  • 15. Saeed ZA, Stiegmann GV, Ramirez FC, Reveille RM, Goff JS, Hepps KS, et al. Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices: a multicenter prospective randomized trial. Hepatol. Baltim. Md., 1997;25:71-74.
  • 16. Sempere L, Palazon JM, Sanchez-Paya J, PASCUAL Pascual S, De Madaria E, Poveda MJ, et al. Assessing the short and long-term prognosis of patients with cirrhosis and acute variceal bleeding. Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig. 2009;101:236-248.
  • 17. Garcia-Tsao G, Bosch J. Varices and Variceal Hemorrhage in Cirrhosis. A new view of an old problem. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2015;13:2109-2117.
  • 18. de Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol. 2015;63: 743–752.
  • 19. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922–938.
  • 20. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017;65:310-335.
  • 21. Yoo J-J, Chang Y, Cho EJ, Moon JE, Kim SG, Kim YS, et al. Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding. World J. Gastroenterol. 2018;24(44):5025–5033.
  • 22. Huh CW, Kim JS, Jung DH, Yang JD, Nam SW, Kwon JH, et al. Optimal endoscopy timing according to the severity of underlying liver disease in patients with acute variceal bleeding. Dig Liver Dis. 2019;51(7):993-998.
  • 23. Cheung J, Soo I, Bastiampillai R, Zhu Q, Ma M. Urgent vs. non-urgent endoscopy in stable acute variceal bleeding. Am J Gastroenterol. 2009;104(5):1125-9.
  • 24. Jung DH, Huh CW, Kim NJ, Kim B-W. Optimal endoscopy timing in patients with acute variceal bleeding: A systematic review and meta-analysis. Scientific Reports. 2020;10:4046
  • 25. Toshikuni N, Takuma Y, Tsutsumi M. Management of gastroesophageal varices in cirrhotic patients: current status and future directions. Annals of Hepatology. 2016;15 (3): 314-325
  • 26. Wells M, Chande N, Adams P, Beaton M, Levstik M, Boyce E, et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012;35:1267-1278.
  • 27. Bañares R, Albillos A, Rincón D, Alonso S, González M, Ruiz-del-Arbol L, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002;35:609-615.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Mustafa ÇALIK (Sorumlu Yazar)
University of Health Sciences Gaziosmanpaşa Training and Research Hospital ,Department of Emergency Medicine
0000-0002-3184-2943
Türkiye


Kader IRAK
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
0000-0002-0019-3207
Türkiye

Teşekkür I would like to thank Associate Professor Deniz Öğütmen Koç for her unwavering support.
Erken Görünüm Tarihi 1 Ocak 2022
Yayımlanma Tarihi 15 Mart 2022
Kabul Tarihi 17 Kasım 2021
Yayınlandığı Sayı Yıl 2022, Cilt 12, Sayı 2

Kaynak Göster

AMA Çalık M. , Irak K. Efficacy of Endoscopic Band Ligation in the Treatment of Acute Esophageal Varicose Bleeding. J Contemp Med. 2022; 12(2): 223-227.