Sarin S K, Govil A, Jain A K, Guptan R C, Issar S K, Jain M, Murthy N S
Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
J Hepatol. 1997 Apr;26(4):826-32. doi: 10.1016/s0168-8278(97)80248-6.
BACKGROUND/AIMS: Endoscopic variceal ligation and endoscopic sclerotherapy are both recommended for the prevention of variceal rebleeding. To compare their efficacy, their influence on gastric varices and the development of portal gastropathy, 95 patients with variceal bleeding were studied.
The patients were randomized to receive weekly endoscopic sclerotherapy using alcohol (n=48) or endoscopic variceal ligation (n=47). The endoscopic sclerotherapy and endoscopic variceal ligation groups were comparable in etiology, severity of liver disease and grade of varices.
In the arrest of acute bleed, endoscopic sclerotherapy and endoscopic variceal ligation were comparable (86% vs. 80%, p=ns). Endoscopic variceal ligation as compared to endoscopic sclerotherapy, obliterated esophageal varices in fewer sessions (4.1+/-1.2 vs. 5.2+/-1.8, p<0.01) and a shorter time (4.4+/-1.3 vs. 6.9+/-3.4 wk, p<0.01). Three (6.4%) patients bled after endoscopic variceal ligation and 10 (20.8%) after endoscopic sclerotherapy (p<0.05). The actuarial percentage of variceal recurrence during a follow-up of 8.5+/-4.4 months, was higher after endoscopic variceal ligation than endoscopic sclerotherapy (28.7% vs 7.5%, p<0.05). Esophageal stricture formation after endoscopic sclerotherapy occurred in five (10.4%) patients, but in none after endoscopic variceal ligation. Significantly more patients developed gastropathy after endoscopic sclerotherapy than ligation (20.5% vs. 2.3%; p=0.02). Endoscopic sclerotherapy (52%) and endoscopic variceal ligation (59%) were equally effective in obliterating the lesser curve gastric varices. Six patients died: three in each group.
(i) Endoscopic sclerotherapy and endoscopic variceal ligation were equally effective in controlling acute bleed; (ii) endoscopic ligation achieved variceal obliteration faster and in fewer treatment sessions; (iii) endoscopic variceal ligation had a significantly lower rate of development of portal gastropathy and rebleeding, (iv) while both techniques influenced gastric varices equally, there was significantly higher esophageal variceal recurrence after endoscopic variceal ligation than sclerotherapy.
背景/目的：内镜下静脉曲张结扎术和内镜下硬化疗法均被推荐用于预防静脉曲张再出血。为比较它们的疗效、对胃静脉曲张的影响以及门静脉性胃病的发生情况，对95例静脉曲张出血患者进行了研究。
将患者随机分为两组，一组每周接受使用酒精的内镜下硬化疗法（n = 48），另一组接受内镜下静脉曲张结扎术（n = 47）。内镜下硬化疗法组和内镜下静脉曲张结扎术组在病因、肝病严重程度和静脉曲张分级方面具有可比性。
在控制急性出血方面，内镜下硬化疗法和内镜下静脉曲张结扎术效果相当（86%对80%，p = 无显著性差异）。与内镜下硬化疗法相比，内镜下静脉曲张结扎术使食管静脉曲张消失所需的疗程更少（4.1±1.2对5.2±1.8，p<0.01），时间更短（4.4±1.3对6.9±3.4周，p<0.01）。3例（6.4%）患者在内镜下静脉曲张结扎术后出血，10例（20.8%）在内镜下硬化疗法后出血（p<0.05）。在8.5±4.4个月的随访期间，内镜下静脉曲张结扎术后静脉曲张复发的精算百分比高于内镜下硬化疗法（28.7%对7.5%，p<0.05）。内镜下硬化疗法后有5例（10.4%）患者发生食管狭窄，而内镜下静脉曲张结扎术后无1例发生。内镜下硬化疗法后发生胃病的患者明显多于结扎术（20.5%对2.3%；p = 0.02）。内镜下硬化疗法（52%）和内镜下静脉曲张结扎术（59%）在消除胃小弯静脉曲张方面同样有效。6例患者死亡：每组各3例。
（i）内镜下硬化疗法和内镜下静脉曲张结扎术在控制急性出血方面同样有效；（ii）内镜下结扎术能更快且以更少的治疗疗程使静脉曲张消失；（iii）内镜下静脉曲张结扎术导致门静脉性胃病和再出血的发生率显著更低；（iv）虽然两种技术对胃静脉曲张的影响相同，但内镜下静脉曲张结扎术后食管静脉曲张复发率明显高于硬化疗法。
