Garcia-Pagán Juan Carlos, Bosch Jaime
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, University of Barcelona, Spain.
Nat Clin Pract Gastroenterol Hepatol. 2005 Nov;2(11):526-35. doi: 10.1038/ncpgasthep0323.
The evidence that endoscopic band ligation (EBL) has greater efficacy and fewer side effects than endoscopic injection sclerotherapy has renewed interest in endoscopic treatments for portal hypertension. The introduction of multishot band devices, which allow the placement of 5-10 bands at a time, has made the technique much easier to perform, avoiding the use of overtubes and their related complications. EBL sessions are usually repeated at 2 week intervals until varices are obliterated, which is achieved in about 90% of patients after 2-4 sessions. Variceal recurrence is frequent, with 20-75% of patients requiring repeated EBL sessions. According to current evidence, nonselective beta-blockers are the preferred treatment option for prevention of a first variceal bleed, whereas EBL should be reserved for patients with contraindications or intolerance to beta-blockers. Nonselective beta-blockers, probably in association with the vasodilator isosorbide mononitrate, and EBL are good treatment options to prevent recurrent variceal rebleeding. The efficacy of EBL might be increased by combining it with beta-blocker therapy. Patients who are intolerant, have contraindications or bled while receiving primary prophylaxis with beta-blockers must be treated with EBL. In the latter situation, EBL should be added to rather than replace beta-blocker therapy. EBL, in combination with vasoactive drugs, is the recommended form of therapy for acute esophageal variceal bleeding; however, endoscopic injection sclerotherapy can be used in the acute setting if EBL is technically difficult.
与内镜注射硬化疗法相比，内镜下套扎术（EBL）具有更高的疗效和更少的副作用，这使得人们对门静脉高压的内镜治疗重新产生了兴趣。多连发套扎装置的引入，使得一次能够放置5至10个套扎圈，这使得该技术的操作变得更加容易，避免了使用外套管及其相关并发症。EBL治疗通常每隔2周重复进行一次，直到静脉曲张消失，大约90%的患者在2至4次治疗后可实现这一目标。静脉曲张复发很常见，20%至75%的患者需要重复进行EBL治疗。根据目前的证据，非选择性β受体阻滞剂是预防首次静脉曲张出血的首选治疗方案，而EBL应保留给有β受体阻滞剂禁忌证或不耐受的患者。非选择性β受体阻滞剂，可能与血管扩张剂单硝酸异山梨酯联合使用，以及EBL是预防静脉曲张再出血的良好治疗选择。将EBL与β受体阻滞剂治疗相结合可能会提高其疗效。不耐受、有禁忌证或在接受β受体阻滞剂一级预防时出血的患者必须接受EBL治疗。在后一种情况下，应添加EBL而不是取代β受体阻滞剂治疗。EBL与血管活性药物联合使用，是治疗急性食管静脉曲张出血的推荐治疗方式；然而，如果EBL在技术上有困难，内镜注射硬化疗法可用于急性情况。
