ENDOSCOPIC VARICEAL LIGATION IN PROPHYLAXIS OF FIRST VARICEAL BLEEDING IN CIRRHOTIC-PATIENTS WITH HIGH-RISK ESOPHAGEAL-VARICES

To determine the efficacy of endoscopic variceal Ligation (EVL) in pro phylaxis on the rate of first esophageal variceal bleeding, we conduct ed a prospective, randomized trial in 126 cirrhotic patients with no h istory of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage, The e nd-points of the study were bleeding and death. Life-table curves show ed that prophylactic EVL significantly diminished the rate of variceal hemorrhage (12/62 [19%] vs. 38/64 [60%]; P = .0001) and overall morta lity (17/62 [28%] vs. 37/64 [58%]; P = .0011). The a-year cumulative b leeding rate was 19% (12/62) in the EVL group and 60% (38/64) in the c ontrol group, The a-year cumulative mortality rate was 28% (17/62) in the EVL group and 58% (37/64)in the control group. Comparison of Kapla n-Meier estimates of the time to death of both groups showed significa ntly lower mortality in the ligation group (P = .001). Patients underg oing 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 fi rst bleeding in patients with good condition (Child A) than in those w ith decompensated disease (Child B and C). We conclude that prophylact ic EVL can decrease-the incidence of first variceal bleeding and death over a period of 2 years in cirrhotic patients with high-risk esophag eal varices.