SELECTION OF ENDOSCOPIC INTERVENTIONS IN THE PREVENTION OF REBLEEDING IN PATIENTS WITH PORTAL HYPERTENSION

Abstract

Introduction: Bleeding from esophageal varices (varicose veins) is one of the leading causes of death in patients with portal hypertension (PH). The main method of prevention of bleeding is endoscopic procedures. Background: To assess the effectiveness of endoscopic ligation (EL) in the prevention of bleeding varicose veins (VVs) of the esophagus and stomach in patients with PH. Material and Methods: We analyzed the results of treatment of 183 patients with PH who had had previously an episode of bleeding from VVs of esophagus or stomach. All patients observed endoscopic examination to determine the degree of VVs and assess the risk of bleeding. The first group included 96 patients who underwent endoscopic sclerotherapy (ES) polidocanol micropinch in the form of particles; the second group included 87 patients who were produced endoscopic ligation (EL) VVs of the esophagus. Results: The observation period ranged from 18.8±18.6 to 22.2±26.2 months. After EL, in contrast to the ES, a complete obliteration of VVs was less than the number of rebleeding, decreased mortality. At control endoscopy, the recurrence of VVs of the esophagus and stomach was detected in 11.4% patients of the first group and in 3.1% of the second group. After EL, almost all patients were observed complications such as transient dysphagia, chest pain, but often after ES occurred over such terrible complications as pleurisy, sepsis syndrome, dysphagia, and bleeding from ulcers sclerosed plot. Conclusion: The EL method has obvious advantages over the ES.