| Theme | Treatment for Portal Hypertension : Update | |
|---|---|---|
| Title | Endoscopic Variceal Ligation for Esophageal Varices | |
| Publish Date | 2012/02 | |
| Author | Keisuke Kanazawa | Department of Endoscopy, The Jikei University School of Medicine |
| Author | Hiroo Imazu | Department of Endoscopy, The Jikei University School of Medicine |
| Author | Naoki Mori | Department of Endoscopy, The Jikei University School of Medicine |
| Author | Hiroshi Kakutani | Department of Endoscopy, The Jikei University Kashiwa Hospital |
| Author | Hisao Tajiri | Department of Gastroenterology and Hepatology, The Jikei University School of Medicine |
| [ Summary ] | We review literature concerning endoscopic variceal ligation therapy (EVL) for esophageal varices employed in Western countries. Recent data suggest that EVL is superior to endoscopic injection sclerotherapy (EIS) for treatment of bleeding esophageal varices. Therefore, AASLD practice guidelines recommend EVL for bleeding esophageal varices. However, EIS is recommended for patients when EVL is not technically feasible. Regarding the prevention of esophageal variceal hemorrhaging, some meta-analyses suggest that both EVL and nonselective β-blockers are effective in preventing first and second variceal hemorrhaging. These studies showed that post-EVL outcomes, including rebleeding rates, mortality, and adverse event rates, did not differ significantly from those observed with medication therapy. Moreover, the combination of pharmacological and endoscopic therapy for prevention of variceal bleeding has been investigated intensively. Although β-blockers are still applied as a primary and secondary prophylaxis for first-line treatment in Western coutries, EVL is a valid option for the management of varices and variceal hemorrhaging. |
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