Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Clin Transl Gastroenterol. 2020 Dec;11(12):e00285. doi: 10.14309/ctg.0000000000000285.
Compared with endoscopic variceal ligation (EVL), cap-assisted endoscopic sclerotherapy (CAES) improves efficacy in the treatment of small esophageal varices (EVs) but has not been evaluated in the management of medium EVs. The aim of this study was to compare CAES with EVL in the long-term management of patients exhibiting cirrhosis with medium EVs and a history of esophageal variceal bleeding (EVB), with respect to variceal eradication and recurrence, adverse events, rebleeding, and survival.
Cirrhotic patients with medium EVs and a history of EVB were divided randomly into EVL and CAES groups. EVL or CAES was repeated each month until variceal eradication. Lauromacrogol was used as a sclerosant. Patients were followed up until 1 year after eradication.
In total, 240 patients (age: 51.1 ± 10.0 years; men: 70.8%) were included and randomized to the EVL and CAES groups. The recurrence rate of EVs was much lower in the CAES group than in the EVL group (13.0% vs 30.7%, P = 0.001). The predictors for variceal recurrence were eradication by EVL (hazard ratio [HR]: 2.37, P = 0.04), achievement of complete eradication (HR: 0.27, P < 0.001), and nonselective β-blocker response (HR: 0.32, P = 0.003). There was no significant difference in the rates of eradication, rebleeding, requirement for alternative therapy, and mortality or the incidence of complications between groups.
CAES reduces the recurrence rate of EVs with comparable safety to that of EVL in the long-term management of patients presenting cirrhosis with medium EVs and a history of EVB.
与内镜下食管静脉曲张结扎术（EVL）相比，套扎辅助内镜硬化治疗（CAES）可提高治疗小食管静脉曲张（EV）的疗效，但尚未在中 EV 的治疗中进行评估。本研究旨在比较 CAES 与 EVL 在长期管理具有中 EV 病史和食管静脉曲张出血（EVB）病史的肝硬化患者中的疗效，评估包括静脉曲张根除和复发、不良事件、再出血和生存情况。
将具有中 EV 病史和 EVB 病史的肝硬化患者随机分为 EVL 组和 CAES 组。每月重复 EVL 或 CAES 治疗，直至静脉曲张根除。使用聚桂醇作为硬化剂。患者在根除后 1 年进行随访。
共纳入 240 例患者（年龄：51.1 ± 10.0 岁；男性：70.8%），并随机分为 EVL 组和 CAES 组。CAES 组的 EV 复发率明显低于 EVL 组（13.0% vs 30.7%，P = 0.001）。静脉曲张复发的预测因素为 EVL 根除（风险比[HR]：2.37，P = 0.04）、完全根除（HR：0.27，P < 0.001）和非选择性β受体阻滞剂反应（HR：0.32，P = 0.003）。两组间的根除率、再出血率、需要替代治疗的比率、死亡率或并发症发生率均无显著差异。
CAES 可降低具有中 EV 病史和 EVB 病史的肝硬化患者的 EV 复发率，其安全性与 EVL 相当，可作为长期管理的选择。
