Abstract
Endoscopic variceal ligation (EVL) has been popular rapidly, because of the easy technique and useful effects. But EVL is not always safe, we have occasionally experienced some complications and bleeding cases in the patients treated by EVL. We discussed about the problems of early bleeding cases after EVL compared with the contrast no bleeding cases.
We have been performed EVL for the prophylactic treatment of 120 patients, and recognized 5 cases (4.2%) of early bleeding and 4 cases of recurrent bleeding after EVL.
In 5 cases of the early bleeding, there were 4 male cases and 1 female case, and the mean age of cases was 62.2 years old. There were 3 cases of liver cirrhosis associated type C hepatitis viral infection, 1 case of liver cirrhosis due to alcohol and 1 case of extrahepatic portal vein occlusion in the primary liver diseases. The form of esophageal varices before treatment were the all risky varices above F2 level with red color sign. There were 2 cases of first treatment, 2 cases of recurrence after endoscopic injection sclerotherapy (EIS) and 1 case of recurrence after operation in the therapeutic indication. There were 3 cases of class B and 2 cases of class C in the liver function by Child's classification. We didn't recognize the significant difference of liver function between the early bleeding cases and the contrast cases.
It was 5.6 EVL sessions of the mean number for the treatment and 13.2 days of the mean period to bleeding after EVL. Bleeding points were the ulcerative lesions due to EVL. Early bleeding cases had the past history of EIS or operation for esophageal varices and the large hepatocellular carcinoma with portal thrombus. They were also the cases with general complication of diabetes mellitus, nephrotic syndrome and malignant tumor.
In conclusion, though EVL is the less invasive and safe technique for the treatment of esophageal varices, we considered that it was necessary to be careful for the treatment and follow up of the cases with these risk factors and general complications.
