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Endoscopic Ligation of Esophageal Varices
- Michael V. Sivak, Jr., MD; and
- Marc F. Catalano, MD
- Case Western Reserve University, Cleveland, OH; Temple University, Philadelphia, PA. Requests for Reprints: Michael V. Sivak, Jr., MD, University Hospitals of Cleveland, Division of Gastroenterology, 2074 Abington Road, Cleveland, OH 44106.
The report by Laine and colleagues [1], on endoscopic variceal ligation in this issue of Annals, describes promising results using a new endoscopic treatment to stop variceal bleeding and to obliterate esophageal varices.
Not so many years ago the prognosis for patients with variceal hemorrhage was poor. Fortunately, the prognosis has improved substantially during the last two decades, mainly because of an increase in the number of viable options for therapy. The success of endoscopic treatment methods, primarily sclerotherapy, has resulted in a more recent belief that it is possible to treat variceal hemorrhage.
Endoscopic Sclerotherapy
Endoscopic sclerotherapy for variceal bleeding, although described in 1939 [2], was rediscovered in the late 1970s. Soon it became evident that ongoing hemorrhage from a varix could be stopped by the injection of various chemical agents, that this form of intervention decreased the volume of blood transfused, and that additional injection sessions decreased the number of episodes of recurrent bleeding. Sclerotherapy may sometimes be equal or perhaps even superior to portacaval or selective splenorenal shunt surgery in terms of survival and the preservation of hepatic function [3-5]. The results of one trial [6] indicate that endoscopic sclerotherapy decreases the mortality for patients with cirrhosis and variceal bleeding; however, another trial [7] did not find a decrease in mortality. A meta-analysis of seven trials revealed that overall survival for patients with variceal bleeding was improved by sclerotherapy [8]. Thus, it appeared that a definitive treatment for …
