Debernardi Venon Wilma, Elia Chiara, Stradella Davide, Bruno Mauro, Fadda Maurizio, DeAngelis Claudio, Rizzetto Mario, Saracco Giorgio, Marzano Alfredo
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy.
Clinical Nutrition and Dietetics Unit, San Giovanni Battista Hospital, University of Turin, Italy.
Eur J Intern Med. 2014 Sep;25(7):674-9. doi: 10.1016/j.ejim.2014.06.013. Epub 2014 Jul 10.
Endoscopic variceal ligation (EVL) is recommended to treat esophageal varices (EV) in cirrhosis and portal hypertension. A program of endoscopic surveillance is not clearly established. The aim of this prospective randomized trial was to assess the most effective timing of endoscopic monitoring after variceal eradication and its impact on the patient's outcome and on the costs.
A hundred and two cirrhotic patients with esophageal varices treated by EVL were evaluated. After variceal eradication patients were randomized to receive first endoscopic control at 3 (Group 1) and 6 (Group 2) months respectively.
Variceal obliteration was achieved in all patients. Variceal recurrence was observed in 28 cases at the first control (29.1%) without difference between the two groups (32% vs 29% in group 1 and 2 respectively, p=0.75). The incidence of large varices is similar in the two groups (33% vs 38% respectively). Using a multivariate analysis, medical therapy with B blockers was the only independent predictor of lowest risk of variceal recurrence [OR 2.30, 95% CI (1.68-3.26)]. Bleeding related to recurrent varices occurred in 3.1% of cases and was associated with portal thrombosis. Child Pugh score ≥8 was the only predictor of mortality (p=0.0002).
Recurrence of varices after banding ligation is not rare but it is associated with a low risk of variceal progression and bleeding. Accordingly, a first endoscopic control at 6 months after variceal eradication associated with a good risk stratification might be a cost-effective strategy of monitoring.
内镜下静脉曲张套扎术（EVL）被推荐用于治疗肝硬化和门静脉高压症患者的食管静脉曲张（EV）。目前尚未明确建立内镜监测方案。这项前瞻性随机试验的目的是评估静脉曲张根除术后内镜监测的最有效时机及其对患者预后和成本的影响。
对102例接受EVL治疗的肝硬化食管静脉曲张患者进行评估。静脉曲张根除术后，患者被随机分为两组，分别在3个月（第1组）和6个月（第2组）接受首次内镜检查。
所有患者均实现静脉曲张闭塞。首次检查时，28例（29.1%）出现静脉曲张复发，两组之间无差异（第1组和第2组分别为32%和29%，p = 0.75）。两组大静脉曲张的发生率相似（分别为33%和38%）。多因素分析显示，使用β受体阻滞剂进行药物治疗是静脉曲张复发风险最低的唯一独立预测因素[比值比2.30，95%可信区间（1.68 - 3.26）]。3.1%的病例发生与复发性静脉曲张相关的出血，且与门静脉血栓形成有关。Child Pugh评分≥8是死亡率的唯一预测因素（p = 0.0002）。
套扎术后静脉曲张复发并不罕见，但与静脉曲张进展和出血的低风险相关。因此，静脉曲张根除术后6个月进行首次内镜检查并结合良好的风险分层可能是一种具有成本效益的监测策略。
