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Feasibility and potential benefit of maintenance endoscopic variceal ligation in patients with unresectable hepatocellular carcinoma and acute esophageal variceal hemorrhage: a controlled trial.
Gastrointest Endosc. 2001 Jul; 54(1):18-23.GE

Abstract

BACKGROUND

Patients with unresectable hepatoma and acute esophageal variceal bleeding have extremely high rates of recurrent bleeding and mortality. This controlled study evaluates the feasibility and potential benefit of maintenance endoscopic variceal ligation in these patients.

METHODS

Patients with unresectable hepatoma and acute esophageal variceal bleeding underwent emergent endoscopic variceal ligation. After hemostasis, patients were randomized to undergo maintenance or esophageal variceal ligation (EVL) as necessary (demand ligation).

RESULTS

Fifty-four patients underwent maintenance EVL and 55 demanded EVL. One or more subsequent EVL session could be performed in only 30 patients (55.6%) in the maintenance group (actual maintenance ligation). Logistic regression analysis found that hepatic function determines the feasibility of maintenance ligation (Child-Pugh's A+B vs. C, OR 23.00: 95% CI [5.26, 100.66]). The survival and recurrent bleeding rates were similar in both groups. A subgroup analysis of patients with Child-Pugh's A and B hepatic reserve in both the maintenance EVL group (n = 24) and demand EVL group (n = 25) was performed to assess the potential benefit of maintenance ligation. Maintenance ligation reduced the rate of recurrent bleeding compared with demand ligation (p = 0.043). Cox regression showed that portal vein thrombosis and tumors in both hepatic lobes were also factors together with EVL that determined recurrence of bleeding. Survival was similar in both groups.

CONCLUSIONS

Maintenance ligation is feasible in patients with unresectable hepatoma and variceal hemorrhage if they have a good hepatic reserve. Maintenance ligation might lower the rate of recurrent bleeding in this subgroup of patients.

Authors+Show Affiliations

Division of Gastroenterology Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11427836

Citation

Chen, W C., et al. "Feasibility and Potential Benefit of Maintenance Endoscopic Variceal Ligation in Patients With Unresectable Hepatocellular Carcinoma and Acute Esophageal Variceal Hemorrhage: a Controlled Trial." Gastrointestinal Endoscopy, vol. 54, no. 1, 2001, pp. 18-23.
Chen WC, Hou MC, Lin HC, et al. Feasibility and potential benefit of maintenance endoscopic variceal ligation in patients with unresectable hepatocellular carcinoma and acute esophageal variceal hemorrhage: a controlled trial. Gastrointest Endosc. 2001;54(1):18-23.
Chen, W. C., Hou, M. C., Lin, H. C., Lee, F. Y., Yeh, Y. Y., Chang, F. Y., & Lee, S. D. (2001). Feasibility and potential benefit of maintenance endoscopic variceal ligation in patients with unresectable hepatocellular carcinoma and acute esophageal variceal hemorrhage: a controlled trial. Gastrointestinal Endoscopy, 54(1), 18-23.
Chen WC, et al. Feasibility and Potential Benefit of Maintenance Endoscopic Variceal Ligation in Patients With Unresectable Hepatocellular Carcinoma and Acute Esophageal Variceal Hemorrhage: a Controlled Trial. Gastrointest Endosc. 2001;54(1):18-23. PubMed PMID: 11427836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Feasibility and potential benefit of maintenance endoscopic variceal ligation in patients with unresectable hepatocellular carcinoma and acute esophageal variceal hemorrhage: a controlled trial. AU - Chen,W C, AU - Hou,M C, AU - Lin,H C, AU - Lee,F Y, AU - Yeh,Y Y, AU - Chang,F Y, AU - Lee,S D, PY - 2001/6/28/pubmed PY - 2001/8/31/medline PY - 2001/6/28/entrez SP - 18 EP - 23 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 54 IS - 1 N2 - BACKGROUND: Patients with unresectable hepatoma and acute esophageal variceal bleeding have extremely high rates of recurrent bleeding and mortality. This controlled study evaluates the feasibility and potential benefit of maintenance endoscopic variceal ligation in these patients. METHODS: Patients with unresectable hepatoma and acute esophageal variceal bleeding underwent emergent endoscopic variceal ligation. After hemostasis, patients were randomized to undergo maintenance or esophageal variceal ligation (EVL) as necessary (demand ligation). RESULTS: Fifty-four patients underwent maintenance EVL and 55 demanded EVL. One or more subsequent EVL session could be performed in only 30 patients (55.6%) in the maintenance group (actual maintenance ligation). Logistic regression analysis found that hepatic function determines the feasibility of maintenance ligation (Child-Pugh's A+B vs. C, OR 23.00: 95% CI [5.26, 100.66]). The survival and recurrent bleeding rates were similar in both groups. A subgroup analysis of patients with Child-Pugh's A and B hepatic reserve in both the maintenance EVL group (n = 24) and demand EVL group (n = 25) was performed to assess the potential benefit of maintenance ligation. Maintenance ligation reduced the rate of recurrent bleeding compared with demand ligation (p = 0.043). Cox regression showed that portal vein thrombosis and tumors in both hepatic lobes were also factors together with EVL that determined recurrence of bleeding. Survival was similar in both groups. CONCLUSIONS: Maintenance ligation is feasible in patients with unresectable hepatoma and variceal hemorrhage if they have a good hepatic reserve. Maintenance ligation might lower the rate of recurrent bleeding in this subgroup of patients. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/11427836/Feasibility_and_potential_benefit_of_maintenance_endoscopic_variceal_ligation_in_patients_with_unresectable_hepatocellular_carcinoma_and_acute_esophageal_variceal_hemorrhage:_a_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(01)13034-8 DB - PRIME DP - Unbound Medicine ER -