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Management of different types of gastric varices with band ligation

a 3-year experience

Seleem, Waseem M.; Hanafy, Amr S.

European Journal of Gastroenterology & Hepatology: August 2017 - Volume 29 - Issue 8 - p 968–972
doi: 10.1097/MEG.0000000000000893
Original Articles: Liver Failure
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Background and aim Gastric varices (GVs) occur with an incidence of 20% in patients with portal hypertension. The aim of this study was to evaluate the efficacy of endoscopic band ligation (BL) as an option in the management of small-to-moderate nonbleeding GVs in cirrhotic patients.

Patients and methods A total of 50 patients (GOV2; n=6, IGV1; n=34, IGV2; n=10) with nonbleeding small-to-moderate-sized GVs without local risk signs of bleeding, such as large size, red-colored elevated areas or red wales, and systemic factors of bleeding risk such as an international normalized ratio of at least 2 and a platelet count of 80 000/µl or less were subjected to endoscopic BL. The patients were followed up every 2 weeks for 1 month and then every 1.5 months for 6 months. The primary outcome was GV eradication, detection of complications such as postprocedural bleeding ulceration and mortality.

Results The mean number of BL sessions was 2.2±0.8; post-BL ulceration occurred in two (4%) patients (n=2 in IGV1, P=0.61), bleeding occurred in one (2%) patient (n=1 in IGV1, P=0.79), and epigastric pain occurred in six (12%, n=4 in GOV2, n=2 in IGV1) patients. There was no mortality reported among patients treated with BL.

Conclusion Endoscopic BL resulted in better outcome and a lower incidence of complications when used to treat small-to-medium-sized nonbleeding GVs. Further, early eradication can save effort and cost, thus avoiding the future risk of treatment of large or risky GVs with sclerotherapy.

Department of Internal Medicine, Endoscopy Unit, Division of Gastroenterology and Hepatology, Zagazig University, Zagazig, Egypt

Correspondence to Amr S. Hanafy, MD, 40, Mostafa Fouad Street, Zagazig 44519, Sharkia, Egypt Tel: +20 552377179; e-mails: amrhanafy@zu.edu.eg; dr_amr_hanafy@yahoo.com

Received February 14, 2017

Accepted April 7, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.