Kim Dong Hyun, Cho Eunae, Jun Chung Hwan, Son Dong Jun, Lee Myeon Jae, Park Chang Hwan, Cho Sung Bum, Park Seon Young, Kim Hyun Soo, Choi Sung Kyu, Rew Jong Sun
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Korean J Gastroenterol. 2018 Oct 25;72(4):188-196. doi: 10.4166/kjg.2018.72.4.188.
BACKGROUND/AIMS: The success rate of endoscopic variceal ligation (EVL) is about 85-94%. There is only a few studies attempting to determine the cause of EVL failure, and to date, on-site rescue treatments remains unestablished. This study aimed to elucidate the risk factors for EVL failure and the effectiveness of on-site rescue treatment.
Data of 454 patients who underwent emergency EVL at Chonnam National University Hospital were retrospectively analyzed. Enrolled patients were divided into two groups: the EVL success and EVL failure groups. EVL failures were defined as inability to ligate the varices due to poor endoscopic visual field, or failure of hemostasis after band ligation for the culprit lesion.
Forty-seven patients experienced EVL failure. In the multivariate analysis, male patients, initial hypovolemic shock, active bleeding on endoscopy, and history of previous EVL were independent risk factors for EVL failure. During endoscopic procedure, we came across the common causes of EVL failure, including unsuctioned varix due to previous EVL-induced scars followed by insufficient ligation of the stigmata and inability to ligate the varix due to poor endoscopic visual field. Endoscopic variceal obturation using N-butyl-2-cyanoacrylate (48.9%) was the most commonly used on-site rescue treatment method, followed by insertion of Sangstaken Blakemore tube (14.9%), and EVL retrial (12.8%). The rescue treatments successfully achieved hemostasis in 91.7% of those in the EVL failure group.
The risk factors of EVL failure should be considered before performing EVL, and in case of such scenario, on-site rescue treatment is needed.
背景/目的：内镜下静脉曲张结扎术（EVL）的成功率约为85%-94%。仅有少数研究试图确定EVL失败的原因，并且迄今为止，现场抢救治疗方法尚未确立。本研究旨在阐明EVL失败的危险因素及现场抢救治疗的有效性。
回顾性分析454例在全南国立大学医院接受急诊EVL的患者的数据。纳入的患者分为两组：EVL成功组和EVL失败组。EVL失败定义为由于内镜视野不佳无法结扎静脉曲张，或对责任病灶进行套扎后止血失败。
47例患者经历了EVL失败。多因素分析显示，男性患者、初始低血容量性休克、内镜检查时活动性出血以及既往EVL史是EVL失败的独立危险因素。在内镜操作过程中，我们发现了EVL失败的常见原因，包括既往EVL导致的瘢痕使静脉曲张无法被吸净，进而对出血点结扎不足，以及由于内镜视野不佳无法结扎静脉曲张。使用N-丁基-2-氰基丙烯酸酯进行内镜下静脉曲张闭塞术（48.9%）是最常用的现场抢救治疗方法，其次是插入三腔二囊管（14.9%）和再次进行EVL（12.8%）。抢救治疗在91.7%的EVL失败组患者中成功实现了止血。
在进行EVL之前应考虑EVL失败的危险因素，若出现这种情况，则需要进行现场抢救治疗。
