ENDOSCOPY IN PREVENTION AND TREATMENT OF ESOPHAGEAL AND GASTRIC VARICEAL BLEEDINGS

Aims:

Estimate and improve methods of treatment of the patients with esophageal and gastric varices, control of portal bleedings using the method of endoscopic varices ligation (EVL) in esophagus and stomach and the role and limitations of placing of Danish stent.

Methods:

We applied plastic ligatures and ligating device in esophagus and stomach. We applied rubber-band ligators only in esophagus. We placed Danish stent in cases of severe portal bleeding and when we had to postpone emergency EVL bacause of severe erosive esophagitis combined with bleeding.

Results:

We perform EVL since 1998 year. We analized 325 EVL to 216 patients with the portal hypertension and large esophageal and gastric varices (Baveno VI). We ligated varices in subcardia and gastric fundus with plastic ligatures in 34% of cases with 86% of efficiancy. We never used rubber-band ligators for it. Complications after EVL: cutting of ligated varices in stomach – 2 (1,8%).

We placed Danish stent in 9 cases. Haemostasis in 100% of cases. Four patints died in 1 – 2 days because of hepatic failure. Others peceived postponed EVL after stent extration. The follow-up is up to 12 years. Subsequent examinations were held every 6 – 12 months. Patients with Child-Pugh C (27%) had the worst prognosis. Most of them died from hepatic failure or accidents, deaths not related with bleeding.

All the patients received combined drug therapy.

Conclusions:

EVL with plastic ligatures is effective in prophylaxis and treatment of variceal bleeding, even in stomach. Danish stent can temporary control the bleeding and allow to postpone EVL. Endoscopic treatment of esophageal and gastric varices decreases the rate of death because of variceal bleedings, but does not treats the main disease. Patients with Child-Pugh C assembe the group of a high risk of complications and mortality.