Stiegmann G V, Goff J S, Michaletz-Onody P A, Korula J, Lieberman D, Saeed Z A, Reveille R M, Sun J H, Lowenstein S R
Department of Surgery, University of Colorado, Denver.
N Engl J Med. 1992 Jun 4;326(23):1527-32. doi: 10.1056/NEJM199206043262304.
Endoscopic sclerotherapy is an accepted treatment for bleeding esophageal varices, but it is associated with substantial local and systemic complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, may be safer. We compared the effectiveness and safety of the two techniques.
In this randomized trial we compared endoscopic sclerotherapy and endoscopic ligation in 129 patients with cirrhosis who had proved bleeding from esophageal varices. Sixty-five patients were treated with sclerotherapy, and 64 with ligation. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications and recurrences of bleeding, the number of treatments needed to eradicate varices, and survival.
Active bleeding at the first treatment was controlled by sclerotherapy in 10 of 13 patients (77 percent) and by ligation in 12 of 14 patients (86 percent). Slightly more sclerotherapy-treated patients had recurrent hemorrhage during the study (48 percent vs. 36 percent for the ligation-treated patients, P = 0.072). The eradication of varices required a lower mean (+/- SD) number of treatments with ligation (4 +/- 2 vs. 5 +/- 2, P = 0.056) than with sclerotherapy. The mortality rate was significantly higher in the sclerotherapy group (45 percent vs. 28 percent, P = 0.041), as was the rate of complications (22 percent vs. 2 percent, P less than 0.001). The complications of sclerotherapy were predominantly esophageal strictures, pneumonias, and other infections.
Patients with cirrhosis who have bleeding esophageal varices have fewer treatment-related complications and better survival rates when they are treated by esophageal ligation than when they are treated by sclerotherapy.
内镜下硬化疗法是治疗食管静脉曲张出血的一种公认疗法，但它会引发大量局部和全身并发症。内镜下套扎术是一种治疗静脉曲张出血的新型内镜治疗方法，可能更为安全。我们比较了这两种技术的有效性和安全性。
在这项随机试验中，我们比较了内镜下硬化疗法和内镜下套扎术对129例已证实有食管静脉曲张出血的肝硬化患者的疗效。65例患者接受硬化疗法治疗，64例接受套扎术治疗。急性出血的初始治疗后进行选择性再次治疗以根除静脉曲张。患者平均随访10个月，在此期间我们确定并发症的发生率、出血复发情况、根除静脉曲张所需的治疗次数以及生存率。
首次治疗时的活动性出血在13例接受硬化疗法治疗的患者中有10例（77%）得到控制，在14例接受套扎术治疗的患者中有12例（86%）得到控制。在研究期间，接受硬化疗法治疗的患者复发出血的比例略高（48%，而接受套扎术治疗的患者为36%，P = 0.072）。与硬化疗法相比，根除静脉曲张所需的平均（±标准差）治疗次数套扎术更少（4±2次与5±2次，P = 0.056）。硬化疗法组的死亡率显著更高（45%对28%，P = 0.04），并发症发生率也是如此（22%对2%，P＜0.001）。硬化疗法的并发症主要是食管狭窄、肺炎和其他感染。
有食管静脉曲张出血的肝硬化患者接受食管套扎术治疗时，与硬化疗法相比，治疗相关并发症更少，生存率更高。
