Brullet E, Espinós J, Campo R, Viver J M, Calvet X, Forné M, Dalmau B, Fernández A, Gil M, Canet J J, Mas Y P
Servicio de Endoscopia Digestiva, Consorci Hospitalari Parc Tauli, Sabadell, Barcelona.
Gastroenterol Hepatol. 1996 Aug-Sep;19(7):339-43.
The aim of the present study was to determine the usefulness of elastic band ligation in the prevention of hemorrhage recurrence by esophageal varices. Forty-five patients without known hepatocarcinoma who had survived a hemorrhagic variceal episode were included in the study. Seventeen patients (38%) were Child-Pugh A, 22 (49%) B, and 6 (13%) C, with the hepatitis C virus and alcohol being the etiology of cirrosis in 55 and 20% of the cases, respectively. The first ligation session was performed between the third and fifth days after the hemorrhagic episode and the posterior sessions were carried out at intervals of 2-4 weeks. The ligation sessions were performed without antibiotic prophylaxis and with placement of an overtube. A mean of 4 +/- 2 bands were placed per session (range, 1-8) and the mean number of sessions required per patient to achieve erradication of the varices was 3.5 +/- 1.5 (range, 2-8). The rate of bleeding recurrence was 17.7% (9 episodes, five by variceal rupture and four by ulcer secondary to ligation). All the episodes of bleeding recurrence occurred between the sessions, with the mortality being 11% (5/45 patients). In the 40 remaining patients the varices were erradicated although 19 (47.5%) required one or two additional sessions of sclerotherapy. The accumulated percentage of patients free of bleeding recurrence was 82% during a mean follow-up of 10.2 +/- 6.7 months. Ten lesions of dislaceration of the esophageal mucosa caused by placement of the were observed overtube. In conclusion, endoscopic elastic band ligation is a useful technique for the erradication of esophageal varices an in the prevention of bleeding recurrence.
本研究的目的是确定弹性橡皮圈套扎术在预防食管静脉曲张出血复发方面的有效性。45例无肝癌病史且静脉曲张出血发作后存活的患者纳入本研究。17例（38%）患者为Child-Pugh A级，22例（49%）为B级，6例（13%）为C级，丙型肝炎病毒和酒精分别是55%和20%病例肝硬化的病因。首次套扎在出血发作后的第3至5天进行，后续套扎每隔2 - 4周进行一次。套扎操作未使用抗生素预防，且放置了外套管。每次套扎平均放置4±2个橡皮圈（范围1 - 8个），每位患者根除静脉曲张所需的平均套扎次数为3.5±1.5次（范围2 - 8次）。出血复发率为17.7%（9次发作，5次因静脉曲张破裂，4次因套扎后继发溃疡）。所有出血复发均发生在套扎间隔期，死亡率为11%（45例患者中有5例）。在其余40例患者中，静脉曲张被根除，尽管19例（47.5%）需要额外进行一到两次硬化治疗。在平均10.2±6.7个月的随访期间，无出血复发患者的累积百分比为82%。观察到10例因放置外套管导致的食管黏膜撕裂损伤。总之，内镜下弹性橡皮圈套扎术是根除食管静脉曲张和预防出血复发的一种有效技术。
