Comparison Of The Efficacy Of Endoscopic Variceal Ligation And Ligation Sequential Sclerotherapy In The Treatment Of Gastroesophageal Varices In Hepatic Cirrhosis And The Effect On Patients’ Liver Function

Objective: To explore the efficacy of endoscopic variceal ligation(EVL)and endoscopic sequential variceal ligation plus sclerotherapy(EVLS)in the treatment of hepatic cirrhosis with gastroesophageal varices and the effect on liver function.Methods:Retrospective analysis of 179 patients with hepatic cirrhosis combined with gastroesophageal varices admitted to the Second Hospital of Hebei Medical University from January 2014 to December 2020.All patients were divided into EVL group(n=93)and into EVLS group(n=86)according to the endoscopic treatment of varices.Basic information,endoscopic examination and treatment results of the patients were counted.The clinical data such as markers of hepatocyte damage(alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,γ-gamma-glutamyl transpeptidase),total bilirubin,liver synthetic function indicators(prealbumin,cholinesterase,prothrombin time,fibrinogen)and Child-Pugh grade were recorded before and after the endoscopic treatment.To compare the effects of endoscopic treatment and changes in markers of hepatocyte damage,total bilirubin,liver synthesis indicators and Child-Pugh grade before,during and 1month after treatment between the two groups.Results:1.The mean number of treatments in EVLS group was 4.0(3.0-5.0),and the mean duration of treatment was 4.9(3.0-6.5)months,while 2.0(2.0-3.0)and 2.0(1.3-4.4)months in EVL group,with statistically significant difference between the two groups(P<0.05).The clinical efficacy and rebleeding rate within 1 year were significantly better in EVLS group(86.0%,27.9%)than in EVL group(51.6%,48.4%),and the difference was statistically significant(P<0.05).There was no significant difference in the number of ligatures,number of ligature rings,early rebleeding rate and complication rate between the two groups(P>0.05).2.There was no significant difference between the two groups before and after treatment in alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase andγ-gamma-glutamyl transpeptidase(P>0.05),whileγ-gamma-glutamyl transpeptidase decreased significantly after treatment in EVLS group compared with EVL group,and the difference was statistically significant(P<0.05).The difference in total bilirubin before and after treatment in EVL group was not statistically significant(P>0.05),while total bilirubin decreased significantly after treatment in EVLS group compared with that before(P<0.05).Pre-albumin,cholinesterase,prothrombin time and fibrinogen were significant improvement in both groups after treatment than before,and pre-albumin and fibrinogen were significantly higher in the sequential group after treatment than in the ligature group,with a statistically significant difference(P<0.05).The liver function Child-Pugh grade improved in both groups after treatment,and the improvement was more obvious in EVLS group than in EVL group,and the difference was statistically significant(P<0.05).Conclusions:1.Endoscopic variceal ligation and endoscopic sequential variceal ligation plus sclerotherapy are safe and effective in the treatment of gastroesophageal varices in hepatic cirrhosis,with few complications,and can improve liver function to some extent.2.Compared with ligature treatment,ligature plus sclerotherapy has a higher rate of varices improvement,a lower 1-year rebleeding rate and a more significant improvement in liver function.