Results of prophylactic endoscopic variceal ligation (EVL) in cirrhotic patients six months post surgery
Main Article Content
Abstract
A prospective, longitudinal descriptive study was conducted to evaluate the clinical and paraclinical characteristics and 6-month follow-up outcomes of 179 cirrhotic patients with esophageal varices (EV) who underwent prophylactic endoscopic variceal ligation (EVL) at the Endoscopy Center of Hanoi Medical University Hospital (January 2024 – August 2025). The mean age of the patients was 61.21 ± 9.93 years old, with a male predominance (88.3%). The majority of patients had Child-Pugh A cirrhosis (52%) and grade III esophageal varices (98.3%). 57% had total esophageal involvement 91.1% had variceal size ≥ 5 mm and 92.2% had red color signs. Mild to moderate post-ligation chest pain occurred in 20.1%. The use of non-selective beta-blockers (NSBBs) reduced the re-ligation rate to 0.54 times compared to the non-user group (95% CI excluded 1). Prophylactic esophageal variceal ligation is a safe procedure with a low complication rate. The recurrence rate is closely associated with patients’ adherence to non-selective beta-blocker therapy.
Article Details
Keywords
Prophylactic esophageal variceal ligation, cirrhosis
References
2. Biecker E. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension. ISRN Hepatol. 2013;2013:541836. doi:10.1155/2013/541836
3. De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-974. doi:10.1016/j.jhep.2021.12.022
4. Shaheen NJ, Stuart E, Schmitz SM, et al. Pantoprazole reduces the size of postbanding ulcers after variceal band ligation: A randomized, controlled trial. Hepatology. 2005;41(3):588-594. doi:10.1002/hep.20593
5. Wang X, Luo J, Liu C, et al. Impact of variceal eradication on rebleeding and prognosis in cirrhotic patients undergoing secondary prophylaxis. Annals of Translational Medicine. 2021;9(7):540-540. doi:10.21037/atm-20-3401
6. An Y, Xu X, Ren T, et al. Adherence to Non-Selective Beta Blockers for Prevention of Variceal Bleeding in Cirrhotic Patients. IJGM. 2021;14:6713-6724. doi:10.2147/IJGM.S326192
7. Hashizume M, Kitano S, Yamaga H, Koyanagi N, Sugimachi K. Endoscopic classification of gastric varices. Gastrointestinal Endoscopy. 1990;36(3):276-280. doi:10.1016/S0016-5107(90)71023-1
8. Trần Thị Mai Cúc. Đánh giá hiệu quả của nội soi thắt tĩnh mạch thực quản trong dự phòng chảy máu tiêu hoá ở người bệnh xơ gan. Tạp chí Y học Việt Nam. 2019; tập 483, số đặc biệt
9. Razafindrazoto CI, Randriamifidy NH, Rakotomalala JA, et al. Endoscopic variceal ligation in primary and secondary prevention of variceal bleeding: a retrospective study in Digestive Endoscopy Unit, University Hospital Joseph Raseta. Befelatanana, Antananarivo, Madagascar. Egypt Liver Journal. 2023;13(1):60. doi:10.1186/s43066-023-00295-3
10. Omar MM, Attia MH, Mostafa IM. 3545 Prophylactic band ligation to prevent first bleeding from large esophageal varices. Gastrointestinal Endoscopy. 2000;51(4):AB122. doi:10.1016/S0016-5107(00)14245-2
11. Nguyễn Quốc Việt, Nguyễn Thị Thảo, Hà Văn Kim, Trần Thanh Hà. Đánh giá kết quả điều trị xuất huyết tiêu hóa do tăng áp lực tĩnh mạch cửa bằng kỹ thuật thắt vòng cao su tại Bệnh viện Nhiệt đới Trung ương. Tạp chí Truyền nhiễm Việt Nam. Số 03(47) - 2024.
12. Vadera S, Yong CWK, Gluud LL, Morgan MY. Band ligation versus no intervention for primary prevention of upper gastrointestinal bleeding in adults with cirrhosis and oesophageal varices. Cochrane Database Syst Rev. 2019 Jun 20;2019(6):CD012673. doi: 10.1002/14651858.CD012673.pub2
13. Simonetto DA, Shah VH. Primary prophylaxis of esophageal variceal bleeding. Clin Liver Dis (Hoboken). 2012;1(5):147-150. doi:10.1002/cld.92
14. Trần Phạm Chí, Hoàng Trọng Thảng. Nghiên cứu điều trị hiệu quả dự phòng chảy máu tái phát bằng Propranolol và Propranolol phối hợp thắt giãn tĩnh mạch thực quản ở bệnh nhân xơ gan. Tạp chí Y Dược học - Trường Đại học Y Dược Huế - 2013; Số 15