학술논문
Endoscopic variceal ligation in primary and secondary prevention of variceal bleeding: a retrospective study in Digestive Endoscopy Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
Document Type
Article
Author
Razafindrazoto, Chantelli Iamblaudiot; Randriamifidy, Nitah Harivony; Rakotomalala, Jolivet Auguste; Rakotondrasoa, Sedera Radoniaina; Ralaizanaka, Behoavy Mahafaly; Rakotoniaina, Henintsoa; Randrianiaina, Antsa Fihobiana; Rakotomaharo, Mialitiana; Laingonirina, Domoina Harivonjy Hasina; Maherison, Sonny; Rasolonjatovo, Anjaramalala Sitraka; Rakotozafindrabe, Andry Lalaina Rinà; Rabenjanahary, Tovo Harimanana; Razafimahefa, Soloniaina Hélio; Ramanampamonjy, Rado Manitrala
Source
Subject
*SECONDARY prevention
*UNIVERSITY hospitals
*PORTAL hypertension
*HEMORRHAGE
*ENDOSCOPY
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Language
ISSN
2090-6218
Abstract
Introduction: Endoscopic variceal ligation (EVL) is a crucial procedure for the primary and secondary prevention of variceal bleeding. The objective of this study was to evaluate the efficacy and tolerability of EVL in the prevention of variceal bleeding. Methods: This was a retrospective, single-center study over 8 years, from January 2013 to December 2020, including all patients who came for EVL in primary or secondary prevention. Results: Fifty-seven patients (male/female: 39/18) were included. The mean age of the patients was 40.02 ± 12.32 years (range: 19–68). Portal hypertension was secondary to cirrhosis in 13 patients (22.8%) and to a non-cirrhotic cause in 44 patients (77.2%). EVL was indicated for primary and secondary prevention in 5.3% and 94.7%, respectively. All patients had received propranolol with a mean daily dose of 108.07 ± 38.52 mg (extremes: 80–160). Eradication of varices was achieved in 33 patients (57.9%) with an average of 3.06 ± 0.70 sessions (extremes: 1–5) and an average duration of 10.12 ± 6.21 months (extremes: 1–24). Ten patients (17.5%) had variceal bleeding, and one patient (1.8%) died. There was no significant difference between patients with cirrhotic and non-cirrhotic portal hypertension in terms of varices eradication, variceal bleeding, and mortality. Gender (HR: 37.18; CI: 0.14–18.4; p = 0.009) and the number of previous bleeds (HR: 1.34; CI: 1.01–1.80; p = 0.041) were independent predictors of variceal bleeding during EVL. Dysphagia (73.7%) and retrosternal pain (78.9%) were the main adverse events after ligation. Conclusion: EVL is an efficient technique to eradicate varices. Its tolerance is good with post-ligation signs that are rapidly regressive. [ABSTRACT FROM AUTHOR]