Endoscopic Ligation plus Argon Plasma Coagulation for Esophageal Variceal Bleeding in Non-alcoholic Patients with Cirrhosis

Background and Study Aims: Esophageal variceal bleeding (EVB) is a severe complication of cirrhosis leading to significant morbidity and mortality. The aim of this study was to determine whether endoscopic variceal ligation (EVL) and argon plasma coagulation (APC) are effective procedures for initial hemostasis, rate of rebleeding, mortality and reducing variceal recurrence.

Patients and Methods: A total of 81 cirrhotic patients between April 2003 and March 2009 were identified with EVB were involved in this study and received emergency endoscopic sclerotherapy (ES) or EVL. Child-Pugh score in ES group was class B in 33 patients and class C in 9 patients. Child-Pugh score in EVL group was class B in 27 patients and class C in 5 patients. After control of active bleeding survived patients received EVL alone and APC after EVL for eradication of esophageal verices. The comparison of variceal recurrence was performed between EVL alone and EVL combined with APC. Endoscopic ultrasonography (EUS) was performed to improve the efficiency of complete elimination of esophageal varices.

Results: During the study period control of active bleeding was achieved in 35 (83%) of 42 patients after ES and in 30 (93%) of 32 patients after EVL. Rebleeding occur in 12 (34%) of 35 patients after ES and in 2 (7%) of 30 patients after EVL. The mortality rate was 57% in ES group and 34% in EVL group. After control of active bleeding EVL alone was performed in 12 patients and APC after EVL was performed in 7 patients for eradication of esophageal verices. During the course of the study no serious complications after ES, EVL and APC were noted.

To determine the therapeutic outcome patients were followed up endoscopic examination at 6-month intervals. Variceal recurrence after EVL alone occurred in 6 (50%) of 12 patients and in 1 (14%) of 7 patients after EVL combined with APC during 18 month follow-up time.

Conclusion: Esophageal variceal ligation has proved more effective than sclerotherapy and is the endoscopic treatment of choice for esophageal varices. EVL combined with APC is safe and effective for reducing the rate of variceal recurrence. EUS-guided APC was performed to improve the efficiency of complete elimination of esophageal varices.