EVL (Endoscopic Variceal Ligation) Plus Vasoconstrictor vs.Ligation Plus PPI( Proton Pump Inhibitor) in the Control of Acute Esophageal Variceal Bleeding

Launched by NATIONAL SCIENCE AND TECHNOLOGY COUNCIL, TAIWAN · Apr 27, 2010

Keywords

ClinConnect Summary

Previous studies showed that combination of endoscopic therapy with vasoconstrictor is better than either vasoconstrictor or endoscopic therapy alone in achieving the successful hemostatsis of acute variceal bleeding. The rationale of using vasoconstrictor is to enhance the efficacy of hemostasis by endoscopic therapy. Nowadays, endoscopic variceal ligation (EVL) has replaced endoscopic injection sclerotherapy (EIS) as the endoscopic treatment of choice in the arresting of acute esophageal variceal hemorrhage. EVL alone can achieve hemotasis up to 97% even in cases of active variceal hemorr...

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Eligibility criteria

• Inclusion Criteria:
• • The etiology of portal hypertension is cirrhosis.
• • Age ranges between 18-80 y/o.
• • Patients presenting with acute esophageal variceal bleeding proven by emergency endoscopy within 12 hours. (Acute esophageal variceal bleeding was defined as: (1) when blood was directly seen by endoscopy to issue from an esophageal varix (active bleeding), or (2) when patients presented with red color signs on their esophageal varices with blood in esophagus or stomach and no other potential site of bleeding identified (inactive bleeding).
• • EVL is performed after confirmation of acute esophageal variceal bleeding. Enrollment time: Immediately after EVL is completed and variceal bleeding is arrested.
• Exclusion Criteria:
• • Association with severe systemic illness, such as sepsis, COPD, uremia
• • Association with gastric variceal bleeding
• • Failure in the control of bleeding by emergency EVL
• • Moribund patients, died within 12 hours of enrollment
• • Uncooperative
• • Ever received EIS, EVL within one month prior to index bleeding
• • Child-Pugh's scores \> 13