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Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding
Author(s) -
Bian Shu,
Tian Xiang Guo,
Hu Jin Hua,
Wang Guang Chuan,
Zhang Chun Qing
Publication year - 2013
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12049
Subject(s) - medicine , esophageal varices , ligation , cyanoacrylate , gastroenterology , percutaneous , embolization , varices , gastric varices , prospective cohort study , varix , surgery , portal hypertension , cirrhosis , chemistry , adhesive , organic chemistry , layer (electronics)
Objective To compare the efficiency of percutaneous transhepatic variceal embolization ( PTVE ) plus endoscopic variceal ligation ( EVL ) with EVL alone in the treatment of esophageal variceal bleeding. Methods Cirrhotic patients with recent esophageal variceal bleeding from J anuary 2007 to D ecember 2011 were collected and assigned to PTVE + EVL ( N = 41) or EVL ( N = 47) groups. We performed chart reviews and prospective follow‐up to determine variceal rebleeding, recurrence of varices and survival. Results During the follow‐up period, recurrence of esophageal varices (EV) occurred in 8 patients (19.5%) in the PTVE + EVL group and 23 (48.9%) in the EVL group ( P = 0.004). The time to recurrence of EV was 9.2 ± 2.7 months and 4.9 ± 2.1 months, respectively. Three patients (7.3%) in the PTVE + EVL group and 12 (25.5%) in the EVL group experienced rebleeding from all sources ( P = 0.023). One patient (2.4%) in the PTVE + EVL group and 7 (14.9%) in the EVL group experienced rebleeding from EV ( P = 0.024). Multivariate C ox analysis indicated that the treatment method was the only predictor of rebleeding. There was no significant difference in the survival rate between the two groups. Conclusion With adequate and permanent obliteration of EV and their feeding veins, the combination of PTVE with cyanoacrylate and EVL is more effective than EVL alone in the prevention and treatment of EV recurrence and rebleeding.