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Eur J Intern Med. 2014 Sep;25(7):674-9. doi: 10.1016/j.ejim.2014.06.013. Epub 2014 Jul 10.

Prospective randomized trial: endoscopic follow up 3 vs 6 months after esophageal variceal eradication by band ligation in cirrhosis.

Author information

1
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: wilmadebernardi@yahoo.it.
2
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: eliachiara@gmail.com.
3
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: davidestr@alice.it.
4
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: mbruno@molinette.piemonte.it.
5
Clinical Nutrition and Dietetics Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: mfadda@molinette.piemonte.it.
6
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: eusdeang@hotmail.com.
7
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: mrizzetto@molinette.piemonte.it.
8
Gastroenterology Unit, San Luigi Gonzaga Hospital, University of Turin, Italy. Electronic address: giorgiomaria.saracco@unito.it.
9
Gastro-Hepatology Unit, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: alfredomarzano@yahoo.it.

Abstract

BACKGROUND AND OBJECTIVES:

Endoscopic variceal ligation (EVL) is recommended to treat esophageal varices (EV) in cirrhosis and portal hypertension. A program of endoscopic surveillance is not clearly established. The aim of this prospective randomized trial was to assess the most effective timing of endoscopic monitoring after variceal eradication and its impact on the patient's outcome and on the costs.

METHODS:

A hundred and two cirrhotic patients with esophageal varices treated by EVL were evaluated. After variceal eradication patients were randomized to receive first endoscopic control at 3 (Group 1) and 6 (Group 2) months respectively.

RESULTS:

Variceal obliteration was achieved in all patients. Variceal recurrence was observed in 28 cases at the first control (29.1%) without difference between the two groups (32% vs 29% in group 1 and 2 respectively, p=0.75). The incidence of large varices is similar in the two groups (33% vs 38% respectively). Using a multivariate analysis, medical therapy with B blockers was the only independent predictor of lowest risk of variceal recurrence [OR 2.30, 95% CI (1.68-3.26)]. Bleeding related to recurrent varices occurred in 3.1% of cases and was associated with portal thrombosis. Child Pugh score ≥8 was the only predictor of mortality (p=0.0002).

CONCLUSIONS:

Recurrence of varices after banding ligation is not rare but it is associated with a low risk of variceal progression and bleeding. Accordingly, a first endoscopic control at 6 months after variceal eradication associated with a good risk stratification might be a cost-effective strategy of monitoring.

KEYWORDS:

Band ligation; Bleeding; Esophageal varices; Portal hypertension

PMID:
25018142
DOI:
10.1016/j.ejim.2014.06.013
[Indexed for MEDLINE]
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