COMBINED LIGATION AND PARAVARICEAL INJECTION SCLEROTHERAPY FOR ESOPHAGEAL VARICES: OUTCOME OVER 3 YEARS

Abstract

Endoscopic variceal ligation (EVL) performed without sclerotherapy has shown a high recurrence rate in early postoperative period compared to endoscopic injection sclerotherapy alone. The recurrence is thought to be related to the persistence of small vessels adjacent to the normal esophageal mucosa and the ligated varices. In an attempt to reduce this high recurrence rate, we employed a combined therapy using ligation and endoscopic paravariceal injection sclerotherapy (EIS) in 40 patients. Sixteen patients (40%) with circumferential ulcer of the lower esophagus treated with combined therapy had no evidence of recurrent varices over the 3-year follow-up period. This suggests that prolonged eradication of esophageal varices was achieved with the use of combined therapy in patients with circumferential ulcer. Unfortunately, 11 of these 16 patients (68.9%) developed an esophageal stricture which had to be dilated postoperatively. The postoperative cumulative 3-year recurrence rate for patients without circumferential ulcer was 55.0 % in F₀RC (-) patients, and 92.8% in F₁RC (-) patients after initial treatment. The recurrence rate was within one-year in F₁RC (-) patients and approximately two years in F₀RC (-) patients. We conclude, therefore, the initial objective of the Combined therapy should be the eradication of esophageal varices with circumferential ulcer. Recurrences may be predicted by incomplete ulcer formation and residual persistence of small vessels. Prophylactic endoscopic injection sclerotherapy should be added to the treatment regimen in patients with these high risk endoscopic findings.