3549 Recurrence of esophageal varices after outpatient endoscopic variceal ligation.

Objective: This study developed EVL as an outpatient technique and assessed recurrence of esophageal varices 12 months after initial eradication. Frequency of complications, rebleeding, hepatic transplantation and death were also studied. Methods: The population included patients with portal hypertension and esophageal varices, with endoscopy documented bleeding and not submitted to sclerotherapy. Eradication was defined as absence of varices upon insuflation of the esophagus or presence of grade I varices without red color sign. Recurrence was defined as the appearance of grade II or III varices in patients whose varices had been eradicated. An association with the following was searched: sex; age; etiology; Child-Pugh classification; variceal grading (I- IV); banding system; number of endoscopic sessions and number of rings. The associations between factors and outcomes were analyzed in terms of relative risk. Significance was determined using the chi-square or Fisher s exact test. Additional comparisons between quantitative variables were made using Student s t-test and Mann-Whitney's U-test. The effect of all factors under study was simultaneously evaluated by Cox s regression models.We also calculated Kaplan-Meyer s curves for variceal recurrence. Results: Fifty-five patients were studied (males = 41 or 74.5% ; medium age=53.1 ± 13.44, range=24-81 years) being 51 cirrhotics (Child-Pugh grade A=22 or 43.1 %, grade B=23 or 45.1 % and grade C=6 or 11.7 % ) and 4 subjects with portal thrombosis without cirrhosis. Varices were invariably grade II or III and 48/55 (87%) had eradication after an average of 4.1 ± 1.88 sessions/per patient. Transitory complications (mild dysphagia and/or odynophagia) occurred in 16 individuals (29.1 %) but 1 had an esophageal perforation attributed to the endoscopic overtube. This patient recovered well after esophagorraphy. Rebleeding occurred in 5/55 (9.1 %) and hepatic transplant was carried on in 6/55 subjects(10.9%). Medium follow-up was 478 ± 347.85 days. In the 25 patients who had a followup greater than or equal to 12 months after eradication, esophageal varices recurred in eight (8/25 or 32 %). Mortality caused by EVL was zero but ten patients died of cirrhosis complications, without detectable digestive hemorrhage. Conclusions: Recurrence of varices after initial eradication is frequent after a follow-up period greater than or equal to 12 months.