Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2024; 30(5): 440-449
Published online Feb 7, 2024. doi: 10.3748/wjg.v30.i5.440
Evaluation of the efficacy and safety of endoscopic band ligation in the treatment of bleeding from mild to moderate gastric varices type 1
Yue Deng, Ya Jiang, Tong Jiang, Ling Chen, Hai-Jun Mou, Bi-Guang Tuo, Guo-Qing Shi
Yue Deng, Tong Jiang, Ling Chen, Hai-Jun Mou, Bi-Guang Tuo, Guo-Qing Shi, Department of Gastroenterology, Digestive Disease Hospital, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Yue Deng, Department of Gastroenterology, Guizhou Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guiyang 550000, Guizhou Province, China
Ya Jiang, Department of Gastroenterology, Yinjiang Autonomous County People’s Hospital, Tongren 554300, Guizhou Province, China
Co-first authors: Yue Deng and Ya Jiang.
Author contributions: Deng Y and Jiang Y designed the research study and wrote the paper; Jiang Y, Mou HJ, and Shi GQ contributed to the surgical operations and provided clinical advice; Tuo BG supervised the study; Jiang T and Chen L contributed to the analysis and interpretation of the data; Shi GQ approved the final version of the article to be published.
Supported by the Guizhou Provincial Science and Technology Program, No. [2020]4Y004.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Zunyi Medical University.
Informed consent statement: Patients were not required to give informed consent to participate in the study because the analysis used anonymous clinical data that were obtained after each patient agreed to the treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Qing Shi, MM, Chief Doctor, Department of Gastroenterology, Digestive Disease Hospital, The Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi 563000, Guizhou Province, China. sgqing973@sina.com
Received: October 3, 2023
Peer-review started: October 3, 2023
First decision: December 4, 2023
Revised: December 15, 2023
Accepted: January 11, 2024
Article in press: January 11, 2024
Published online: February 7, 2024
Processing time: 119 Days and 14.5 Hours
Abstract
BACKGROUND

According to practice guidelines, endoscopic band ligation (EBL) and endoscopic tissue adhesive injection (TAI) are recommended for treating bleeding from esophagogastric varices. However, EBL and TAI are known to cause serious complications, such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI. However, the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage (GOV1) has not been determined. Therefore, the aim of this study was to discover an individualized treatment for mild to moderate GOV1.

AIM

To compare the efficacy, safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.

METHODS

A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted. Patients were allocated to an EBL group or an endoscopic TAI group. The differences in the incidence of varicose relief, operative time, operation success rate, mortality rate within 6 wk, rebleeding rate, 6-wk operation-related ulcer healing rate, complication rate and average operation cost were compared between the two groups of patients.

RESULTS

The total effective rate of the two treatments was similar, but the efficacy of EBL (66.7%) was markedly better than that of TAI (39.2%) (P < 0.05). The operation success rate in both groups was 100%, and the 6-wk mortality rate in both groups was 0%. The average operative time (26 min) in the EBL group was significantly shorter than that in the TAI group (46 min) (P < 0.01). The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group (11.8% vs 45.1%) (P < 0.01). At 6 wk after the operation, the healing rate of operation-related ulcers in the EBL group was 80.4%, which was significantly greater than that in the TAI group (35.3%) (P < 0.01). The incidence of postoperative complications in the two groups was similar. The average cost and other related economic factors were greater for the EBL than for the TAI (P < 0.01).

CONCLUSION

For mild to moderate GOV1, patients with EBL had a greater one-time varix eradication rate, a greater 6-wk operation-related ulcer healing rate, a lower delayed rebleeding rate and a lower cost than patients with TAI.

Keywords: Gastric varices; Type 1 gastric variceal hemorrhage; Endoscopic band ligation; Tissue adhesive injection

Core Tip: Endoscopic band ligation (EBL) and endoscopic tissue adhesive injection for the treatment of type 1 gastric variceal hemorrhage (GOV1) are often associated with various complications, which we believe are due to the lack of individualized treatment. Different treatment methods should be used for different degrees of varicose veins. Therefore, this study was based on mild to moderate GOV1 and explored individualized treatment. Ultimately, the use of EBL for mild to moderate GOV1 can achieve better outcomes and reduce both rebleeding rates and treatment costs.