Endoscopic Variceal Ligation (EVL): The More, the Merrier? A Prospective Multicenter Randomized Controlled Study

Endoscopic Variceal Ligation (EVL): The More, the Merrier? A Prospective Multicenter Randomized Controlled Study Jose D. Sollano Jr., Frederick T. Dy, Stephen N. Wong, Melchor M. Chan, Albert E. Ismael, Jose A. Tan, Evan G. Ong, Marvin D. Basco Background: Bleeding from ruptured esophageal varices is a catastrophic sequela of portal hypertension and is associated with a high mortality rate. Endoscopic variceal ligation (EVL) can completely obliterate varices and is currently the treatment of choice for acute variceal bleeding. Due to its low complication rate and ease of deployment, ligating asmany varices as possible in a single sessionmay improve outcomes and cut costs of therapy. The objective of this study is to determine the outcome of deploying more than 6 bands vs. 6 bands or less per session of EVL. Methods: All patients with evidence of active or recent bleeding from esophageal varices with no history of previous EVL, sclerotherapy or intake of beta-blockers for the past 6 months were randomized into two groups (Group 1 >6 bands; Group 2 0.05) although there was more alcoholic cirrhosis in Group 2 (Group 1=21.4% vs. Group 2=51.6%, p=0.03). Mean follow-up was 13.5 +/ 9.7 mos. for all patients. Sessions needed for complete variceal obliteration were similar (Group 1=1.6 vs. Group 2=1.9, p=0.209). There was a failure to achieve complete obliteration in 18%and 13%of patients inGroups 1 and 2, respectively. Therewas no difference in both rebleeding (42.9% vs. 25.8% overall rebleeding; mean interval to rebleeding 13.6 vs. 20 mos.; 2-year rebleeding rate 65.3% vs. 31.8%; Group 1 vs. 2, p=0.182) and survival between the 2 groups (60.7% vs. 71% overall survival; 17.4 vs. 19.7 mos. mean **602 Utility of EUS-FNA in the Evaluation of Primary Lung Mass Shyam Varadarajulu, Brenda J. Hoffman, Robert H. Hawes, Mohamad Eloubeid