Comparison Between Endoscopic Band Ligation and Sclerotherapy in Management of Upper Gastro-Intestinal Hemorrhage Due to Esophageal Varices


ABSTRACT:BACKGROUND: Upper gastrointestinal bleeding is serious complication of portal hypertension which can be treated by different medical and surgical methods with possibility of failure, re-bleeding and death.OBJECTIVE: To evaluate the efficacy of band ligation and Sclerotherapy in controlling initial bleeding, failure of control (during first 24 hours) and re-bleeding within 5 days.PATIENTS AND METHODS:this prospective study was conducted at Gastroenterology and Hepatology Teaching Hospital in Medical city complex in Baghdad from the 1st of January 2010 to the 1st of March 2012.The study engaged 100 consecutive patients who were divided equally into two groups (50 patients each), first group were treated with banding procedure while patients in second group were treated with sclerotherapy and both groups were followed up for 5 days.RESULTS: Neither failure to control bleeding (during first 24 hours) nor death occurred in both groups. Successfulness (no re-bleeding within 5 days) was more common in Band ligation group (94%) rather than sclerotherapy group (90%). On the other hand, 8 patients in both groups all were child-pugh C developed re-bleeding, 3 patients (6%) in Band group and 5 patients (10%) in sclerotherapy group and need second session which was successful in all patients in both procedures , comparison statistically was significant and Band procedure was better than Sclerotherapy procedure, (P. value=0.029) .CONCLUSION: Endoscopic Band ligation is more effective than Sclerotherapy in controlling initial attacks of esophageal varices bleeding and decreasing recurrent attacks of bleeding.KEYWORDS: upper gastro-intestinal bleeding, esophageal varices, liver cirrhosis, portal hypertension.