To determine the efficacy of endoscopic variceal ligation (EVL) in prophylaxis on the rate of first esophageal variceal bleeding, we conducted a prospective, randomized trial in 126 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death. Life-table curves showed that prophylactic EVL significantly diminished the rate of variceal hemorrhage (12/62 [19%] vs. 38/64 [60%]; P = .0001) and overall mortality (17/62 [28%] vs. 37/64 [58%]; P = .0011). The 2-year cumulative bleeding rate was 19% (12/ 62) in the EVL group and 60% (38/64) in the control group. The 2-year cumulative mortality rate was 28% (17/62) in the EVL group and 58% (37/64) in the control group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed significantly lower mortality in the ligation group (P = .001). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. The lower risk in the EVL group was attributed to a rapid reduction of variceal size. Prophylactic EVL was more efficient in preventing first bleeding in patients with good condition (Child A) than in those with decompensated disease (Child B and C). We conclude that prophylactic EVL can decrease the incidence of first variceal bleeding and death over a period of 2 years in cirrhotic patients with high-risk esophageal varices.

译文

为了确定内镜下静脉曲张结扎术(EVL)预防第一次食道静脉曲张破裂出血的疗效,我们对126例无既往有上消化道出血史且经内镜检查认为是食管静脉曲张的肝硬化患者进行了一项前瞻性随机试验。高出血风险。研究的终点是出血和死亡。生命表曲线表明,预防性EVL显着降低了曲张静脉出血的发生率(12/62 [19%] vs. 38/64 [60%]; P = .0001)和总死亡率(17/62 [28%] vs 37/64 [58%]; P = 0.0011)。 EVL组的2年累积出血率为19%(12/62),对照组为60%(38/64)。 EVL组的2年累积死亡率为28%(17/62),对照组为58%(37/64)。 Kaplan-Meier对两组死亡时间的估计值的比较表明,结扎组的死亡率显着降低(P = .001)。接受EVL的患者几乎没有治疗失败,主要死于肝功能衰竭。 EVL组中较低的风险归因于曲张静脉大小的迅速减小。预防性EVL预防状况良好的患者(儿童A)比失代偿性疾病的患者(儿童B和C)更有效地防止首次出血。我们得出结论,在高危食管静脉曲张的肝硬化患者中,预防性EVL可以在2年内降低首次静脉曲张破裂出血和死亡的发生率。

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