Prospective randomized trial: Endoscopic follow up 3 vs 6 months after esophageal variceal eradication by band ligation in cirrhosis

• Published in: European journal of internal medicine 2014-09, Vol.25 (7), p.674-679
• Main Authors: Debernardi Venon, Wilma, Elia, Chiara, Stradella, Davide, Bruno, Mauro, Fadda, Maurizio, DeAngelis, Claudio, Rizzetto, Mario, Saracco, Giorgio, Marzano, Alfredo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Endoscopy, Gastrointestinal - methods; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - surgery; Female; Follow-Up Studies; Humans; Internal Medicine; Ligation; Liver Cirrhosis - complications; Male; Middle Aged; Prospective Studies; Time Factors; Treatment Outcome
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2014.06.013

Abstract Background and objectives Endoscopic variceal ligation (EVL) is recommended to treat esophageal varices (EV) in cirrhosis and portal hypertension. A program of endoscopic surveillance is not clearly established. The aim of this prospective randomized trial was to assess the most effective timing of endoscopic monitoring after variceal eradication and its impact on the patient's outcome and on the costs. Methods A hundred and two cirrhotic patients with esophageal varices treated by EVL were evaluated. After variceal eradication patients were randomized to receive first endoscopic control at 3 (Group 1) and 6 (Group 2) months respectively. Results Variceal obliteration was achieved in all patients. Variceal recurrence was observed in 28 cases at the first control (29.1%) without difference between the two groups (32% vs 29% in group 1 and 2 respectively, p = 0.75). The incidence of large varices is similar in the two groups (33% vs 38% respectively). Using a multivariate analysis, medical therapy with B blockers was the only independent predictor of lowest risk of variceal recurrence [OR 2.30, 95% CI (1.68–3.26)]. Bleeding related to recurrent varices occurred in 3.1% of cases and was associated with portal thrombosis. Child Pugh score ≥ 8 was the only predictor of mortality (p = 0.0002). Conclusions Recurrence of varices after banding ligation is not rare but it is associated with a low risk of variceal progression and bleeding. Accordingly, a first endoscopic control at 6 months after variceal eradication associated with a good risk stratification might be a cost-effective strategy of monitoring.