Percutaneous Transhepatic Variceal Embolization With TH Glue Versus Endoscopic Ligatin In Esophago-gastric Variceal Bleeding Management

Objective:Bleeding of esophagogastric varices is one of the severe complications in patients with cirrhosis,and the control and prevention of bleeding is very important.Here in we report a modified PTVE with TH glue in which the whole lower esopha-geal and peri or para-esophageal varices,the submucosal varices,and the advertitial plexus of the cardia and fundus were sufficiently obliterated.To assess its long-dated effect,We compared this PTVE with endoscopic band ligation(EVL)in the treatment of esophagogastric variceal bleeding in this article.Methods:Patients which were admitted to Shandong Provincial Hospital between July 2003 and November 2006 were assigned to PTVE(52 patients) or EVL(50 patients) groups.In the PTVE groups,the portal vein was first punctured under fluoroscopy guidance,then portography was carried out to assess the varices and the afferent veins.The left gastric vein was then selected for venography to evaluate the size of varices,blood flow velocity,the amount of contrast medium needed to fill the varices, and the duration of contrast medium presence in the varices and in the drainage veins. Based on these data,the injection speed and volume of TH glue were determined.The above procedure was repeated to immobilize other afferent veins of varices,whenever they existed.The EVL procedure was repeated every 2-3 weeks until variceal eradication was achieved.Endoscopy follow-up was performed to detect the recurrence of any varices in both groups.For patients in the PTVE group,abdominal B-ultrasound,upper abdominal CT scan and portal venography were performed to determine the effect of embolization and thrombosis formation in portal vein.Upper gastrointestinal(UGI) rebleeding,esophageal variceal rebleeding,and survival rate were followed-up. Statistical analyses were performed by use of SPSS 13.0 software.Results:Both groups were performed with a procedural success rate of 100%.During the follow-up period(median 24 and 25 months in the PTVE and EVL groups,respectively) UGI rebleeding rate is 15.4%(8/52 ) and 42%(21/50)(χ~2 =8.87,P=0.004 ), respectively.The rebleeding rate from esophageal varices is 5.8%(3/52)和24%(12/50) (χ~2=5.38,P=0.012),respectively.The recurrent rate of esophageal varices is 17.3% (9/52)和52%(26/50)(χ~2=13.61,P＜0.001),respectively.However there was no significant difference between survival in the two groups(χ~2=3.30,P=0.054).Conclusion:the clinical and follow-up results of CT scan and endoscopy indicated that:(1) They have a similar acute hemostatic results,but PTVE was more effective than EVL in the management of esophageal varices recurrence and rebleeding which shows PTVE is a proper interventional treatment technology to prevent esophageal and gastric varices rebleeding.(2) PTVE modified with TH glue can sufficiently obliterate the whole lower esophageal and peri or para-esophageal varices,the submucosal varices,and the adventitial plexus of the cardia and fundus widely and permanently.That is the pathologic basis.(3) The associated complications rate of PTVE is higher than EVL,but most is mild.And hepatic function is improved.Survival in these two groups was not significantly different.