Lay C S, Tsai Y T, Teg C Y, Shyu W S, Guo W S, Wu K L, Lo K J
Division of Gastroenterology, 803 Army General Hospital, Taiwan, Republic of China.
Hepatology. 1997 Jun;25(6):1346-50. doi: 10.1002/hep.510250608.
To determine the efficacy of endoscopic variceal ligation (EVL) in prophylaxis on the rate of first esophageal variceal bleeding, we conducted a prospective, randomized trial in 126 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death. Life-table curves showed that prophylactic EVL significantly diminished the rate of variceal hemorrhage (12/62 [19%] vs. 38/64 [60%]; P = .0001) and overall mortality (17/62 [28%] vs. 37/64 [58%]; P = .0011). The 2-year cumulative bleeding rate was 19% (12/ 62) in the EVL group and 60% (38/64) in the control group. The 2-year cumulative mortality rate was 28% (17/62) in the EVL group and 58% (37/64) in the control group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed significantly lower mortality in the ligation group (P = .001). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. The lower risk in the EVL group was attributed to a rapid reduction of variceal size. Prophylactic EVL was more efficient in preventing first bleeding in patients with good condition (Child A) than in those with decompensated disease (Child B and C). We conclude that prophylactic EVL can decrease the incidence of first variceal bleeding and death over a period of 2 years in cirrhotic patients with high-risk esophageal varices.
为确定内镜下静脉曲张结扎术（EVL）预防首次食管静脉曲张出血发生率的疗效，我们对126例既往无上消化道出血史、内镜检查判断食管静脉曲张有高出血风险的肝硬化患者进行了一项前瞻性随机试验。研究的终点为出血和死亡。生存曲线显示，预防性EVL显著降低了静脉曲张出血率（12/62 [19%] 对比 38/64 [60%]；P = .0001）和总死亡率（17/62 [28%] 对比 37/64 [58%]；P = .0011）。EVL组的2年累积出血率为19%（12/62），对照组为60%（38/64）。EVL组的2年累积死亡率为28%（17/62），对照组为58%（37/64）。两组Kaplan-Meier估计的死亡时间比较显示，结扎组死亡率显著更低（P = .001）。接受EVL的患者治疗失败较少，主要死于肝衰竭。EVL组风险较低归因于静脉曲张大小迅速减小。预防性EVL在病情良好（Child A级）的患者中预防首次出血比在失代偿性疾病（Child B级和C级）患者中更有效。我们得出结论，预防性EVL可降低高危食管静脉曲张肝硬化患者2年内首次静脉曲张出血和死亡的发生率。
