Comparison Of Endoscopic Ligation Or Sclerotherapy Alone Versus Sequentially Use For The Secondary Prophylaxis Of Esophageal Variceal Bleeding

Objective:Evaluate the long-term results of endoscopic band ligation or endoscopic sclerotherapy alone versus sequentially use these two therapies in secondary prophylaxis on esophageal variceal bleeding.Methods:From September2011to December2013,169cirrhosis patients with esophageal varices were selected from those people adopted in our hospital. They are divided into three groups:ligation alone (EVL group), sclerotherapy alone (EIS group), sequential therapy with ligation and sclerotherapy (EVLS group). Comparing the medical records and endoscopy reports of three groups’patients to assessed the efficacy of the above treatment methods.Results:1. The difference of the varices eradication rate and response rate (markedly effective rate plus effective rate) between single EVL and EIS groups was not statistically significant. But EVL group have a higher markedly effective rate than EIS group (P=0.036) while EIS group’s mortality is higher than EVL group (P=0.010);2、At the end of the follow-up, EVLS group showed a higher eradication rate than EVL and EIS groups (P=0.016, P=0.044) but no significant difference in response rate (P=0.59, P=0.24); EVLS group showed a less mean quantity of therapy than the EVL and EIS groups (P=0.001, P=0.04) and a lower dose of sclerotherapy than EIS group (P<0.001);3、The overall complications rates between three groups showed no significant difference (P=0.107) but the incidence of fever in EIS and EVLS groups was higher than EVL group (P<0.001, P=0.034); The early rebleeding rate was significantly higher in EIS group than in EVL and EVLS groups (P=0.005); The late rebleeding rate in6m and12m among the three groups have no significant difference, but EVL group has a higher rebleeding rate in24months than EVLS group (P=0.014); The overall mortality was4.1%(7/169), and EIS group was higher than the EVL group (P=0.001). If we consider the mortality rate due to late hemorrhage only in EIS group, the differences among the three groups was not statistically significant (P=0.069).Conclusions:EVL was a faster curative efficacy and higher safety therapy than EIS; EVLS show a better efficacy than EVL and EIS with a higher varices eradication rate. It can reduce the quantity of treatment and the dose of sclerotherapy with the lower recurrence and early bleeding rate than EVL and EIS. So EVLS is a better choice for the secondary prophylaxis of variceal bleeding in cirrhosis patients.