| Objective: Compared with endoscopic variceal sclerotherapy (EVS) and endoscopic variceal ligation (EVL), the safety and efficacy of endoscopic variceal ligation plus sclerotherapy(EVLS) for esophageal variceal bleeding(EVB) was assessed. Methods: One hundred and four patients with esophageal variceal bleeding in liver cirrhosis were assigned into three groups: thirty-eight patients were treated by EVS, forty patients by EVL and twenty-six patients by EVLS. In the EVS group, each spot was injected 3 to 8ml sclerosant and total dosage was below 35ml in one treatment session,further treatment sessions were held 7 to 10 days intervals until eradication of the varices was achieved. Each patient in the EVL group was ligated 4 to 6 rubber bands and retreated two-week intervals until the varices was eradicated. In the EVLS group, sclerotherapy was held after performing one or two sessions of ligation, until the varices was eradicated. The rate of variceal eradication,rebleeding varices recurrence,complication and death were observed during the regular follow-up. Results: The variceal eradication rate was similar in the three groups (EVS:81.6%, EVL:85.7%, EVLS:92.3%, P﹥0.05). The mean session of treatment to obtain eradication in the EVL group was lower than others (EVL: 1.8±0.6, EVS: 3.0±1.0 , EVLS: 2.9±1.0, P﹤0.05). In the EVLS group, the mean band of ligation was lower than the EVL group (7.3±3.0 vs 11.0±3.0, P﹥0.05), and the mean dosage of injection was lower than the EVS group(20.2±10.7 vs 52.9±25.6,P﹤0.05).There was not statistically significant difference in comparison of the rebleeding rate and death rate among the three groups (P﹥0.05). The rate of complication in the EVLS group was significantly lower than the EVS group(19.2% vs 32.7%, P﹤0.05),but higher than the EVL group(16.2% vs 15.1%, P﹥0.05). The rate of varices recurrence in the EVLS group was lower than the EVL group (EVLS: 11.5% vs EVL: 35.0%, P﹤0.05),and similar with EVS group. Conclusions: 1.The variceal eradication rate in the EVS,EVL and EVLS groups was not statistically significant difference,it shows their short-term efficacy was similar and they are the effective methods of therapying esophageal variceal.2.The rate of varices recurrence in the EVLS group was lower than the other groups during the follow-up of six to thirty-six months,maybe for it preclud the deep-layer varicose vein and communicating branch vein, so its long-term efficacy was better.3. The rebleeding rate was similar in the EVS,EVL and EVLS groups; the rebleeding rate of patient with Child-pugh C grade was higher than A grade and B grade. It shows the rebleeding rate relate with Child-pugh C grade. 4. The rate of complication in the EVLS group was lower than the EVS group for its lower dose of injecting and its safety was higher. 5. There was not statistically significant difference in the death rate among the three groups and the prognosis of patient was relation with the reservoir function of liver,the activity of Hepatitis and others complication of Cirrhosis of liver.6.The patients with severe esophageal variceal held by EVS following by EVL can reduce spurting blood after pulling out the injection needle,so its operation safety was significant higher . |
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