Background and aim: Esophageal varices are among the most serious consequences of portal hypertension, the rate of bleeding per year reaches 15% and the rate of mortality reaches 30%. The gold standard for their treatment consists of endoscopic band ligation (EBL), whether or not associated with non-selective beta-blockers. The aims of the study were to: 1. Highlight the basal characteristics that allow the distinction of patients who achieve the eradication from those whose in whom treatment fails; 2. Highlight the basal characteristics that allow the distinction of patients who need only one session of EBL to achieve the eradication from those who need two or more sessions; 3. Identify the factors that can predict the last operational endoscopy before the eradication. Material and methods: This descriptive observational study was carried out in the Department of Gastroenterology and Hepatology of Policlinico Umberto I from March 2016 to May 2017. Fifty-five patients with significant portal hypertension were enrolled and treated with EBL for primary or secondary prophylaxis at the Endoscopic Unit, Department of Surgical Sciences. At hospitalizationthey underwent EBL and they were subsequently re-endoscope at one-month interval until the eradication of varices was achieved. Results: Patients requiring a single endoscopic session to eradicate varices showed significantly smaller varices (p=0.019), less number of bands (p=0.04), absence of diabetes (p=0.01), and better renal function (p<0.001) vs patients who required two or more sessions. Patients in whom endoscopic therapy failed were characterized by the presence of ascites (p=0.01), longer varices (p=0.03), diabetes (p<0.001), and a higher number of bands (p=0.03) vs those in whom EBL obtained varices eradication. Finally, the EBL session that describes short varices (with a proximal margin >30 cm, p=0.01) and needs less than 3 bands (p=0.01) is more likely to be the last before the eradication (Table 1). Multivariate analysis did not select significant independent factors. Conclusions: Our study has highlighted factors that may predict the success and the number of sessions of EBL treatment for esophageal varices. Data needs to be verified in a larger number of patients.
Predictive factors for the eradication of esophageal varices in cirrhotic patient undergoing endoscopic band ligation / Tavano, D.; Palma, R.; Di Gregorio, V.; Panetta, C.; Lattanzi, B.; D'Ambrosio, D.; Raniolo, M.; Incicco, S.; Antoniozzi, A.; Pontone, S.; Lamazza, A.; Merli, M.. - In: DIGESTIVE AND LIVER DISEASE. - ISSN 1590-8658. - STAMPA. - 50:2(2018), p. e191. (Intervento presentato al convegno Fismad 2018 tenutosi a Rome) [10.1016/S1590-8658(18)30548-6].
Predictive factors for the eradication of esophageal varices in cirrhotic patient undergoing endoscopic band ligation
Tavano, D.Writing – Original Draft Preparation
;Palma, R.Investigation
;Di Gregorio, V.Data Curation
;Panetta, C.Data Curation
;Lattanzi, B.Data Curation
;D'Ambrosio, D.Data Curation
;Raniolo, M.Data Curation
;Incicco, S.Data Curation
;Antoniozzi, A.Data Curation
;Pontone, S.Supervision
;Lamazza, A.Writing – Review & Editing
;Merli, M.Supervision
2018
Abstract
Background and aim: Esophageal varices are among the most serious consequences of portal hypertension, the rate of bleeding per year reaches 15% and the rate of mortality reaches 30%. The gold standard for their treatment consists of endoscopic band ligation (EBL), whether or not associated with non-selective beta-blockers. The aims of the study were to: 1. Highlight the basal characteristics that allow the distinction of patients who achieve the eradication from those whose in whom treatment fails; 2. Highlight the basal characteristics that allow the distinction of patients who need only one session of EBL to achieve the eradication from those who need two or more sessions; 3. Identify the factors that can predict the last operational endoscopy before the eradication. Material and methods: This descriptive observational study was carried out in the Department of Gastroenterology and Hepatology of Policlinico Umberto I from March 2016 to May 2017. Fifty-five patients with significant portal hypertension were enrolled and treated with EBL for primary or secondary prophylaxis at the Endoscopic Unit, Department of Surgical Sciences. At hospitalizationthey underwent EBL and they were subsequently re-endoscope at one-month interval until the eradication of varices was achieved. Results: Patients requiring a single endoscopic session to eradicate varices showed significantly smaller varices (p=0.019), less number of bands (p=0.04), absence of diabetes (p=0.01), and better renal function (p<0.001) vs patients who required two or more sessions. Patients in whom endoscopic therapy failed were characterized by the presence of ascites (p=0.01), longer varices (p=0.03), diabetes (p<0.001), and a higher number of bands (p=0.03) vs those in whom EBL obtained varices eradication. Finally, the EBL session that describes short varices (with a proximal margin >30 cm, p=0.01) and needs less than 3 bands (p=0.01) is more likely to be the last before the eradication (Table 1). Multivariate analysis did not select significant independent factors. Conclusions: Our study has highlighted factors that may predict the success and the number of sessions of EBL treatment for esophageal varices. Data needs to be verified in a larger number of patients.| File | Dimensione | Formato | |
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