Analysis Of The Effects For Treatment Of Esophageal Variceal Bleeding (EVB) With Endoscopic Variceal Ligation (EVL)Combined With Sandostatin And Esomeprazole

Objective:The analysis of the effects for treatment of esophageal varicea1bleeding (EVB) with endoscopic variceal ligation (EVL) combined with sando statin and esomeprazole.Methods:78cases of esophageal variceal bleeding in cirrhotic patients wh o were treated by Gastroenterology Department of Qilu hospital and the First h ospital of Zibo City during the period from July,2009to July,2012were ana lyzed. These liver cirrhosis were mainly hepatitis bassociated liver cirrhosis and alcoholic liver cirrhosis and the primary hepatic celluar carcinoma with cirrhos is were ruled out. All patients in these cases had hemorrhages that are express ed in different degrees of hematemesis, melena or hematochezia, or with dizzin ess, fatigue, faint and even shock. Gastroscopy were made when the patients h ave stable life sign that certified there were esophageal varices (part of them were with gastric varices) and upper gastrointestinal hemorrhage caused by pept ic ulcer, Mallory-Weiss syndrome and so on were ruled out. These patients we re randomly divided into two groups:treatment group (22men and16women) that were aged28to83and drug group (26men and14women) that were aged25to78. There were no significant difference of treatment group and dr ug group in sex, age and liver function and were comparable. All patients in t wo groups were given Hemocoagulase and Glutathione and medicine and thera py on the basis of infusion, anemia correction and positive blood supplement. The treatment group and drug group were different in treatment program. The patients in treatment group were given endoscopic variceal ligation and before the operation, these patients were all given influsions of esomeprazole sodium by intravenous drip once/q12h of40mg esomeprazole sodium with100ml sali ne (Nexium produced by AstraZeneca Plc) as well as continuous influsions of domestic sandostatin50μg/h by micro pump for24hours a day. The gastrosco py was made after three days’influsions of esomeprazole sodium and sandostat in and the results were esophageal variceal bleeding. Being agreed by the patie nts, endoscopic variceal ligation were made. The surgical instruments in ligatio n were electronic gastroscope, six endoscopic ligator produced by Wilson-Cook Company. The ligator was installed to the gastroscope and ligation on varicose vein in different planes was made from far end of cardia or bleeding source from bottom to top. The space between adjacent ligation positions were2to3cm and the ligation positions were spiral. The ligation continued at5to10p ositions every time till all varicose veins were ligated. The gastroscope was ta ken out when no active bleeding was found. After the operation, sandostatin in flusion continued48hours (0.4mg every8hours). The patients in drug group were given medical treatment with decreased sandostatin and esomeprazole for continuous5days. All patients in two groups were carried out examinations of liver function, urea nitrogen, creatinine, hemoglobin, blood platelet and white blood cells as well as monitoring of blood pressure, pulse rate, bleeding amou nt and stop time of bleeding before medication and after. The second endoscop ic variceal ligation was made according to patient-based compliance and degree of varicose vein3or4weeks later. The regular follow-up was performed ev ery3months a time after the patients were discharged from hospital to survey the conditions of patients such as rebleeding and death. The death and diseas e outcome within one year were regarded as clinical study endpoint. The succe ss rate of hemostasis, rate of rebleeding and fatality rate were compared betwe en the two groups.Results:comparing the treatment group and the drug group, it is found th at the success rate of hemostasis is100%and82.5%, rate of early rebleeding is2.6%and20%, rate of delayed rebleeding is10.5%and40%and the rate of death due to bleeding is2.6%and20%respectively. The differences of suc cess rate of hemostasis after operation, rate of rebleeding and fatality rate betw een the patients of the two groups were obviously (P<0.05) that has statistical significance.Conclusion:for esophageal variceal bleeding in cirrhotic patients, endosco pic variceal ligation (EVL) combined with sandostatin and esomeprazole is sup erior to sandostatin and esomeprazole alone in effective hemostasis and control of early rebleedingang and reduce the falality rate.