Yol S, Belviranli M, Toprak S, Kartal A
Department of General Surgery, Faculty of Medicine, Selçuk University, 42200, Konya, Turkey.
Surg Endosc. 2003 Jan;17(1):38-42. doi: 10.1007/s00464-002-9033-1. Epub 2002 Oct 8.
The effectiveness of endoscopic clipping in the hemostasis of bleeding esophageal varices and the eventual variceal eradication was compared with that of band ligation.
Forty patients were enrolled in the study in a prospective manner, 19 of whom received endoscopic clipping (group I) and the remaining (n = 21 patients) received endoscopic band ligation (group II). All patients in this study presented with bleeding from esophageal varices. The patient characteristics (age, sex, Child-Pugh score, variceal grade) were comparable in the two groups. After initial hemostasis, the patients were assigned one of the two forms of endoscopic therapy which was continued in the follow-up sessions until varices were eradicated. Early and late results were compared.
Initial hemostasis was achieved in all patients in group I but two patients in group II required clip ligation for initial hemostasis because of the failure in band ligation. Those two were treated with band ligation in the follow-up sessions. A total of 224 clips in 53 treatment sessions and 296 bands in 82 treatment sessions were placed in group I and group II, respectively. The rates of complete variceal eradication were 89% and 76% in group I and group II, respectively (p > 0.05). The median number of required treatment sessions for complete eradication of the varices was significantly lower in group I than group II (3 versus 4, p = 0.013). Three patients from group I (15%) and seven patients from group II (33%) were readmitted for variceal bleeding during the follow-up period (p > 0.05).
With the advantages of high initial hemostasis rate, decreased risk of rebleeding, and fewer treatment sessions needed for variceal eradication, endoscopic clipping is as effective as band ligation, or perhaps more effective in the treatment of bleeding esophageal varices.
比较内镜下套扎术与内镜下金属夹止血术治疗食管静脉曲张破裂出血的疗效及最终静脉曲张根除情况。
前瞻性纳入40例患者，其中19例接受内镜下金属夹止血术（I组），其余21例接受内镜下套扎术（II组）。本研究所有患者均为食管静脉曲张破裂出血。两组患者的特征（年龄、性别、Child-Pugh评分、静脉曲张分级）具有可比性。初始止血后，患者被分配接受两种内镜治疗中的一种，并在后续治疗中持续进行，直至静脉曲张根除。比较早期和晚期结果。
I组所有患者均实现了初始止血，但II组有2例患者因套扎失败需要金属夹结扎来实现初始止血。这2例患者在后续治疗中接受了套扎治疗。I组和II组分别在53次治疗中放置了224个金属夹和在82次治疗中放置了296个套扎圈。I组和II组的静脉曲张完全根除率分别为89%和76%（p>0.05）。I组完全根除静脉曲张所需的治疗次数中位数显著低于II组（3次对4次，p=0.013）。随访期间，I组有3例患者（15%）和II组有7例患者（33%）因静脉曲张出血再次入院（p>0.05）。
内镜下金属夹止血术具有初始止血率高、再出血风险降低以及根除静脉曲张所需治疗次数较少的优点，在治疗食管静脉曲张破裂出血方面与内镜下套扎术效果相当，甚至可能更有效。
