Effects And Safety Of Endoscopic Variceal Ligation And Endoscopic Injection Sclerotherapy In Patients With Cirrhosis And Esophageal Varices: A Prospective Study

Objective: To prospectively determine the efficacy and safety of endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) in patients with esophageal varices. And analyze the risk factors of rebleeding and survival with the Cox proportional hazards model .Method: A total of 68 cases with liver cirrhosis and esophageal varices which received endoscopic treatment from January 2008 to March 2010 at the first Affiliated Hospital of Anhui Medical University, were divided into two groups: EIS (n = 37) and EVL (n = 31). To determine the risk factors of rebleeding and survival and to compare the rate of hemostasis, early rebleeding, delayed rebleeding, mortality and other complications between the two group, a prospective follow-up study of the patients has been taken for 1 year after endoscopic therapy.Result:The patients treated with EVL had a higher rate of hemostasis than with EIS, but the difference was not significant (P = 0.120). The EVL group had a significantly lower probability of early rebleeding (10.0% vs 40.5%, P = 0.005), delayed rebleeding (33.3% vs 59.5%, P= 0.033) and lower mortality(6.7% vs 32.4%,P = 0.010)Furthermore, the patients treated with EVL also had a lower probability of fever (29.0% vs 59.5%, P=0.014), retrosternal pain (32.3% vs 64.9%, P=0.007), esophageal ulcer bleeding(3.2% vs 21.6%, P=0.033), abdominal distention (12.9% vs 45.9%, P=0.003) . Time to rebleeing of the two groups showed that the effect of EVL was superior to that of EIS(χ~2=5.515, P=0.019). The multivariate Cox regression analysis indicated that the cumulative number of episodes of bleeding from esophageal varices more than 3 times was the predictor of rebleeding (HR=4.032, P<0.001). The probability of survival was significantly higher in the EVL group than that in the EIS group. The multivariate Cox regression analysis indicated that the risk of death was significantly higher in EIS group than that in the EVL group (HR = 5.618, P = 0.026). Child-Pugh C (HR = 40.487 , P<0.001) was the risk factor of death, However, more samples and further clinical research are needed.Conclusion:1.EVL is more effective and safer than EIS for esophageal varices, with lower probability of rebleeding and other complications and better survival. EVL is preferred as the first-line treatment in the acute variceal bleeding and the secondary prophylaxis of esophageal variceal bleeding. 2.The cumulative number of episodes of bleeding from esophageal varices more than 3 times is a risk factor of rebleeding.3. Child-Pugh C is the risk factor of death, however, more samples and further clinical research are needed.