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A pilot study on modified endoscopic variceal ligation using endoscopic ultrasonography with color Doppler function
N Nagamine1, N Ueno, T Tomiyama
1Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
The American Journal of Gastroenterology
|February 19, 1998
Summary
This study shows that modified endoscopic variceal ligation (EVL) is a safe and effective treatment for esophageal varices, particularly when gastric varices are undeveloped. The intensive ligation method demonstrated good intermediate-term outcomes.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Medical imaging
Background:
- Esophageal varices pose a significant risk of bleeding.
- Endoscopic variceal ligation (EVL) is a standard treatment.
- Novel techniques like intensive ligation aim to improve outcomes.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of a modified endoscopic variceal ligation (EVL) technique, termed "intensive ligation."
- To assess the utility of endoscopic ultrasonography with color Doppler (EUS-CD) in evaluating variceal hemodynamics before and after the procedure.
Main Methods:
- Modified EVL (intensive ligation) was performed on 45 patients with esophageal varices.
- Variceal hemodynamics were assessed using EUS-CD in 38 patients.
- Patient response and recurrence rates were monitored over time.
Main Results:
- The median nonrecurrence period was 18 months.
- Good responders (n=9) had longer remission (16.9 months) than poor responders (n=5, 5.8 months).
- Undeveloped gastric varices (grade I) were associated with good response, while developed gastric varices (grade III) correlated with poor response (p < 0.05).
Conclusions:
- Modified EVL is safe and effective for intermediate-term management of esophageal varices.
- EUS-CD is valuable for assessing gastric varices and predicting treatment response.
- The intensive ligation method shows promise, especially in patients with undeveloped gastric varices.