Iso Y, Kawanaka H, Tomikawa M, Matsumata T, Kitano S, Sugimachi K
Department of Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan.
Hepatogastroenterology. 1997 Mar-Apr;44(14):467-71.
BACKGROUND/AIMS: The aim of this prospective randomized study is to investigate the safety, efficacy, complications and recurrence of varices after repeated endoscopic injection sclerotherapy (EIS), and combined therapy of endoscopic variceal ligation (EVL) and repeated EIS, for the treatment of esophageal varices.
Sixty-one consecutively treated cirrhotic patients were examined. Thirty patients were placed randomly in the EIS group and the other 31 in the EVL+EIS group. For the EIS group, EIS was repeated at weekly intervals using 5% ethanol- amine oleate (EO) until all the varices had been eradicated. In the EVL+EIS group, EVL was done at the initial session, then EIS was repeated at weekly intervals from one week after EVL.
There was no significant difference between the EIS and EVL+EIS groups with regard to the rate of eradication (80.0% vs 74.2%), the total number of treatment (4.1 +/- 0.8 sessions of EIS vs EVL and 3.0 +/- 0.5 sessions of EIS) and hospitalization time (4.9 +/- 1.6 vs 4.4 +/- 1.0 weeks). The total volume of EO used for the EVL+EIS group was significantly less than that for the EIS group (26.3 +/- 8.3 vs 47.1 +/- 11.6 ml, p < 0.01) and the incidence of minor complications at the initial treatment in the EVL+EIS group was significantly (p < 0.01) lower than that in the EIS group. Follow-up endoscopy showed that the rate of attaining circumferential ulceration and the following fibrotic scarring in the EVL+EIS group was significantly lower than that in the EIS group (21.7% vs 91.7%, p < 0.01) and that the incidence of variceal recurrence was significantly higher in the EVL+EIS group than in the EIS group (39.1% vs 8.3%, p < 0.05) over a median follow-up of 12.3 months.
The combined therapy of EVL and repeated EIS seems favorable from the viewpoint of fewer complications, but repeated EIS is preferable to combined therapy to avoid recurrence of the esophageal varices.
背景/目的：这项前瞻性随机研究的目的是调查重复内镜注射硬化疗法（EIS）以及内镜下静脉曲张结扎术（EVL）联合重复EIS治疗食管静脉曲张后的安全性、疗效、并发症及静脉曲张复发情况。
对61例接受连续治疗的肝硬化患者进行检查。30例患者被随机分为EIS组，另外31例被分入EVL+EIS组。EIS组使用5%油酸乙醇胺（EO）每周重复进行EIS，直至所有静脉曲张均被消除。在EVL+EIS组，初次治疗时进行EVL，然后从EVL后一周起每周重复进行EIS。
EIS组和EVL+EIS组在消除率（80.0%对74.2%）、治疗总次数（EIS组为4.1±0.8次，EVL+EIS组为EVL及EIS 3.0±0.5次）和住院时间（4.9±1.6对4.4±1.0周）方面无显著差异。EVL+EIS组使用的EO总量明显少于EIS组（26.3±8.3对47.1±11.6 ml，p<0.01），且EVL+EIS组初次治疗时轻微并发症的发生率显著低于EIS组（p<0.01）。随访内镜检查显示，EVL+EIS组出现环形溃疡及随后纤维化瘢痕形成的发生率显著低于EIS组（21.7%对91.7%，p<0.01），且在中位随访12.3个月期间，EVL+EIS组静脉曲张复发的发生率显著高于EIS组（39.1%对8.3%，p<0.05）。
从并发症较少的角度来看，EVL联合重复EIS的联合疗法似乎更具优势，但为避免食管静脉曲张复发，重复EIS比联合疗法更可取。
