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Role of band ligation for secondary prophylaxis of variceal bleeding

Ioanna Aggeletopoulou1, Christos Konstantakis1, Spilios Manolakopoulos2

  • 1Department of Gastroenterology, University Hospital of Patras, Patras 26504, Greece.

World Journal of Gastroenterology
|July 19, 2018
PubMed

Insights

Endoscopic band ligation is more effective than sclerotherapy for preventing recurrent variceal bleeding in cirrhosis patients. Combining band ligation with beta-blockers improves outcomes, while TIPS shows promise for rebleeding prevention.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Endoscopic Interventions

Background:

  • Esophageal varices are a serious complication of liver cirrhosis, posing a significant risk of bleeding.
  • Secondary prophylaxis aims to prevent recurrent variceal bleeding, a major cause of mortality in cirrhotic patients.

Purpose of the Study:

  • To critically evaluate the efficacy of endoscopic band ligation for secondary prophylaxis of variceal bleeding in cirrhosis.
  • To summarize recent advances in managing variceal bleeding through evidence-based review.

Main Methods:

  • Comprehensive literature review of MEDLINE and PubMed databases.
  • Inclusion of data from meta-analyses and recent randomized controlled trials (2002-2017).
  • Search terms focused on band ligation, secondary prophylaxis, variceal bleeding, and liver cirrhosis.

Main Results:

  • Endoscopic band ligation demonstrated superiority over endoscopic sclerotherapy in preventing variceal rebleeding.
  • Combination therapy with beta-blockers and band ligation enhanced treatment effectiveness.
  • Transjugular intrahepatic portosystemic shunt (TIPS) showed superior rebleeding prophylaxis compared to combination therapy, with no significant survival difference.

Conclusions:

  • Current evidence supports band ligation, especially when combined with beta-blockers, for secondary prophylaxis of variceal bleeding.
  • Further research is needed to develop innovative treatments for improved clinical outcomes in managing portal hypertension complications.
Abstract

Keywords:
Band ligationEndoscopic therapyEsophageal varicesLiver cirrhosisRebleedingSecondary prophylaxisVariceal bleedingVariceal eradication

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