Abstract
Recently, endoscopic variceal ligation therapy (EVL) has become a valuable alternative to endoscopic injection sclerotherapy (EIS) in the treatment of esophageal varices. However, EVL originally developed is known to suffer early recurrence and bleeding. We have treated 123 patients with esophageal varices with eradicative EVL (eEVL) which uses up to 20 O-rings and evaluated a long-term prognosis and analyzed risk factors for recurrence after eEVL. Cumulative rate of no variceal recurrence was 90.7% at 1 year and 63.6% at 5 years. The rate was higher in Child A than in Child B and C (p = 0.03), in varices with red color sign negative (p = 0.05), with cross-sectional area (CSA) at gastric cardia<100 mm2 before EVL (p = 0.01) with CSA<10 mm2 after eEVL (p = 0.004), and without remaining vessels at the lower esophagus after eEVL (p= 0.007), respectively. Multiple regression analysis revealed that the last factor is the most reliable predictor of recurrence (risk ratio =7.41, p =0.04). From these observations, it is suggested that in order to obtain a long term recurrence-free period submucosal vessel at the lower esophagus should be eradicated at the end of eEVL.
