Endoscopic Injection Sclerotherapy Performed Both By Intravariceal And Paravariceal For Esophageal Variceal Hemorrhage

Background:Esophageal variceal bleeding is an important cause of gastrointestinal bleeding in patients with cirrhoses as well as one of the lethal complications of portal hypertension. It is associated with a mortality of at least20%at6weeks, despite improvements in therapy over the last decade. Drugs sometimes show a poor short-term effect for EVB. Dual-bag and three-cavity stomach catheter has almost been abandoned because of its complications and high rate of re-bleeding after withdrawal. Emergency surgery is associated with a high mortality rate because of the critical condition and poor liver function in patients. TIPS is not accepted as first-line treatment for EVB because of its high technical requirements, and a high rate complicated of hepatic encephalopathy after the treatment. As is widely accepted, both EIS and EVL are effective in the control and prevention of acute variceal bleeding. Both can significantly reduce the rate of rebleeding, improve the survival rate, making EIS and EVL the first-line therapy for EVB. In terms of EIS, it can be performed by intravariceal injection, paravariceal injection and combined injection. At present, EIS was performed mainly by intravariceal injection..But in theory, EIS performed both by intravariceal and paravariceal can eradicate varices and collateral vessels between them, cause the lower esophageal Submucosal tissue fibrosis. Thus can prevent recurrence of varices and decrease the late re-bleeding rate and remarkably. Object:To evaluate the efficacy and safety of endoscopic injection sclerotherapy (EIS) performed both by intravariceal and paravariceal for esophageal variceal hemorrhage.Methods:One hundred and one patients with esophageal variceal hemorrhage had received the sclerotherapy. According to different treatment methods, they were randomly divided into combined injection group and intravariceal injection group. The combined injection group was given sclerosing agent injection both by intravariceal and paravariceal, while the intravariceal injection group was given sclerosing agent injection by intravariceal only. The clinical effect between the two groups was evaluated after two years follow-up.Results:No differences were found between the two groups in bleeding control (100.00%vs96.88%), early re-bleeding rate (6.12%vs11.54%), varices elimination (81.63%vs78.85%), survival rate in two years (81.63%vs76.92%) or complications. But the late re-bleeding rate of the combined injection group was remarkable lower than that of the intravariceal injection group (14.28%vs30.77%, P<0.05). No serious complications such as esophageal perforation, ARDS and ectopic embolism were observed in the two groups.Conclusions:EIS is effective and safe for esophageal variceal hemorrhage. EIS performed by combination of intravariceal and paravariceal injection can decrease the late re-bleeding rate remarkably.