Masumoto H, Toyonaga A, Oho K, Iwao T, Tanikawa K
Second Department of Medicine, Kurume University School of Medicine, Asahi, Japan.
J Gastroenterol. 1998 Feb;33(1):1-5. doi: 10.1080/00365529850166112.
Endoscopic variceal ligation therapy (EVL) seems to be a more effective and safer method than endoscopic injection variceal sclerotherapy (EVS) for treating bleeding esophageal varices. However, EVL may entail a higher recurrence rate than EVS. The aim of this study was to examine whether EVL combined with low-dose EVS reduced the recurrence rate compared to treatment with EVL alone and reduced the complication rate compared to treatment with EVS alone. In this prospective study, 59 patients with cirrhosis and high-risk (F2 or F3, red color sign ++ or ) esophageal varices were enrolled. They were randomly assigned to an EVS group (n = 18), an EVL group (n = 20), and a combination EVL plus low-dose EVS group (n = 21). After the eradication of varices, follow-up endoscopic examinations were carried out for 24 months to determine the recurrence of varices. Complications, e.g., severe dysphagia, fever, renal dysfunction and pleuritis were also evaluated. The recurrence-free rate was significantly lower in the EVL group (60% at 24 months) than in either the EVS group (90%, P < 0.05) or the combination group (88%, P < 0.05). However, no significant difference was found between the EVS group and the combination group. The complication rate was significantly higher in the EVS group (50%) than in either the EVL group (5%, P < 0.01) or the combination group (10%, P < 0.01). The combination therapy seems to be useful to improve the benefits achieved with EVL alone and to reduce the harmful effects induced by EVS alone. EVL plus low-volume EVS is advisable in the treatment of high-risk esophageal varices.
对于治疗食管静脉曲张破裂出血，内镜下静脉曲张套扎术（EVL）似乎是一种比内镜下注射硬化剂治疗术（EVS）更有效、更安全的方法。然而，EVL的复发率可能高于EVS。本研究的目的是检验与单纯EVL治疗相比，EVL联合小剂量EVS是否能降低复发率，以及与单纯EVS治疗相比，是否能降低并发症发生率。在这项前瞻性研究中，纳入了59例患有肝硬化且有高危（F2或F3，红色征++或）食管静脉曲张的患者。他们被随机分为EVS组（n = 18）、EVL组（n = 20）和EVL联合小剂量EVS组（n = 21）。在静脉曲张消除后，进行24个月的随访内镜检查以确定静脉曲张的复发情况。还评估了并发症，如严重吞咽困难、发热、肾功能不全和胸膜炎。EVL组的无复发率（24个月时为60%）显著低于EVS组（90%，P < 0.05）或联合组（88%，P < 0.05）。然而，EVS组和联合组之间未发现显著差异。EVS组的并发症发生率（50%）显著高于EVL组（5%，P < 0.01）或联合组（10%，P < 0.01）。联合治疗似乎有助于提高单纯EVL的疗效，并减少单纯EVS引起的有害影响。在治疗高危食管静脉曲张时，建议采用EVL加小剂量EVS。
