Evaluation of Different Modalities for Prevention of Esophageal Varices Recurrence

Introduction: Esophageal varices are present in 30% of patients with compensated cirrhosis and up to 60% of those with decompensated cirrhosis, Band ligation is the method of choice although injection therapy still has a role in acute bleeding. However varices frequently recur after endoscopic variceal ligation. In view of the unacceptable high rate of recurrence associated with this technique, the availability of other supplemental consolidation therapies is desired. Aim of work: To evaluate and compare different therapeutic approaches used as consolidation therapy including argon plasma coagulator, injection sclerotherapy and B-blockade for their efficacy in prevention of variceal recurrence, recurrent bleeding and complications after eradication by band ligation. Subjects and methods: This study was conducted on 60 patients presented with 1 st attack of upper GIT bleeding, after history taking and physical examination, band ligation of varices was done till obliteration where the patients were classified into 3 groups; group I (20 patients) received argon plasma; group II (20 patients) received paravariceal sclerotherapy with ethanolamine and group III (20 patients) received propranolol. All patients were followed up for 1 year with endoscopy performed every 3 months to check for variceal recurrence. Results: Argon plasma coagulation had the least recurrence rate as compared to other groups (P 0.05). there was no significant difference between Child's A and B class regarding recurrence. The recurrence was statistically related to P.V diameter in groups II fever significantly occurred in group I while exertional dypsnea occurred in group III. Conclusion: Argon plasma coagulation is a safe and effective consolidation therapy following band ligation in prevention of variceal recurrence, recurrent bleeding in comparison with paravariceal sclerotherapy with ethanolamine oleate and use of beta blockers therapy, but is relatively expensive method. (Mohamed M. Abdel-Aal, Sahar G. Zaghloul, Mahmoud A. Ashour and Hoda Abdel-aziz El-hady. Evaluation of Different Modalities for Prevention of Esophageal Varices Recurrence. J Am Sci 2012;8(6):408-416). (ISSN: 1545-1003). http://www.americanscience.org . 51