Comparison Among Sandwich Method Of Combined Endoscopic Variceal Ligation And Sclerotherapy, Endoscopic Variceal Ligation, And Endoscopic Variceal Sclerotherapy For Esophageal Variceal Bleeding

Objective:The aim of this retrospective study was to determine whether a combined endoscopic sandwich method (ligation-sclerotherapy-ligation) could achieve better results than ligation or sclerotherapy alone in the clinical effect of esophageal variceal bleeding. Methods:145 patients with cirrhosis and EVB were retrospectively studied:ligation group of 39 cases, sclerotherapy group of 17 case, sandwich method group of 89 cases. Dense ligation is used in ligation group. Sclerosant was injected intravariceal and paravariceal in sclerotherapy group. Each variceal column was ligated with 2 rubber bands and a little Sclerosant was injected into the variceal column between two ligation sites in sandwich method group.Seven patients underwent angiography of esophageal varices when the first therapeutic session was held in the group of sandwich menthod.Further treatment was held at interval of 7d to 14d until eradication of the varices.Results:The sclerosant was retained in varices for more than 30 mins of the 7 patients who was undergone angiography.No differences were observed among the three methods in stanch bleeding (100% vs 100% vs 100%,eradicating varices (96.6% vs 97.4% vs 94.1%)and mortelity (3.4% vs 2.6% vs 5.9%). A comparison of time required for eradication showed that sandwich method underwent significantly shorter time (18.2±6.0 vs 30.1±9.3 vs 38.6±12.6d). The number of therapeutic sessions of sandwich method were fewer than sclerotherapy (1.5±0.6 vs 3.4±1.0). The rate in early recurrent bleeding (5.6% vs 23.5%) and complications (12.4% vs 41.2%) of sandwich method was significantly lower than sclerotherapy. As regards recurrent (2.2% vs 23.1%) and late recurrent bleeding (7.9% vs 23.1%), sandwich method shows lower than ligation.Conclusions:A combined endoscopic sandwich method shows very rapid eradication of varices, has fewer complications than significantly alone, avoids a high recurrence rate of band ligation alone. The sandwich method can achieve better results than ligation or sclerotherapy alone in the clinical effect of esophageal variceal bleeding.