Usefulness of Combination Therapy of Endoscopic Injection Sclerotherapy and Endoscopic Variceal Lingation for Esophageal Varices-Comparison of Combination Therapy and Two-Step Endoscopic Injection Sclerotherapy-

Abstract

Since 1985, the present authors have been performing a procedure of sclerotherapy for esophageal varices in which paravariceal injection of 1% Aethoxysklerol (AS) is performed in addition to intravariceal injection of 5% ethanolamine oleate (EO) . This particular endoscopic sclerotherapy (EIS) method is designed as the two-step EIS. This procedure is effective for esophageal varices. And endoscopic variceal ligation (EVL) have been established in the management of esophageal varices too. However EVL reported lower eradication rates and higher incidence of variceal recurrence than that of EIS.
Then, the authors developed a procedure of variceal sclero-ligation (VSL) in which injection of 5%EO and ligation were made at the first session for esophageal varices treatment. In the present retrospective study, a total 130 patients in elective and prophylactic cases were evaluated for the methods of two various combination therapies (VSL and metachronous EVL・EIS combination) and two-step EIS.
Complete eradication of esophageal varices could be achieved in 33 (97.1%) of 34 patients treated by the VSL, while in 61 (84.7%) of 72 patients treated by the two-step EIS (p＜0.01) . Eradicaton of esophageal varices by metachronous EVL・EIS combination could be achieved 22 (91.7%) of 24 patients. Total sessions for treatment were not different from three methods. With regard to the total amount of sclerosants, 13.5±6.0ml of 5% EO was used in the VSL, while 24.4±12.1ml of 5% EO was used in the two-step EIS (p＜0.01) . Complications occured in 54 (75.0%) patients treated by the two-step EIS, while in 17 (50.0%) patients treated by the VSL (p＜0.05) .
Variceal sclero-ligation of combination therapy is proposed as safer and more effective procedure of endoscopic therapy for elective and prophylactic cases with esophageal varices.