Comparison among Endoscopic Variceal Obliteration, Endoscopic Band Ligation, and Balloon-occluded Retrograde Transvenous Obliteration for Treatment of Gastric Variceal Bleeding

Seul Ki Min; Sang Gyune Kim; Young Seok Kim; Jun Yong Bae; Jong Chan Lee; Sae Hwan Lee; Hong Soo Kim; Soung Won Jeong; Jae Young Jang; Jong Ho Moon; Moon Sung Lee; Boo Sung Kim

doi:10.4166/kjg.2011.57.5.302

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Min, Kim, Kim, Bae, Lee, Lee, Kim, Jeong, Jang, Moon, Lee, and Kim: Comparison among Endoscopic Variceal Obliteration, Endoscopic Band Ligation, and Balloon-occluded Retrograde Transvenous Obliteration for Treatment of Gastric Variceal Bleeding

Original Article

Korean J Gastroenterol 2011;57(5):302-308.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.5.302

Comparison among Endoscopic Variceal Obliteration, Endoscopic Band Ligation, and Balloon-occluded Retrograde Transvenous Obliteration for Treatment of Gastric Variceal Bleeding

Seul Ki Min, Sang Gyune Kim, Young Seok Kim, Jun Yong Bae, Jong Chan Lee, Sae Hwan Lee, Hong Soo Kim, Soung Won Jeong, Jae Young Jang, Jong Ho Moon, Moon Sung Lee, Boo Sung Kim

Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea

Correspondence to: Young Seok Kim, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, 1174, Jung-dong, Wonmi-gu, Bucheon 420-767, Korea. Tel: +82-32-621-6546, Fax: +82-32-621-5016, E-mail: liverkys@schmc.ac.kr

Received 24 August 20107 December 2010 Accepted 7 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Endoscopic variceal obliteration (EVO), endoscopic variceal ligation (EVL), and balloon-occluded retrograde transvenous obliteration (BRTO) are used to manage gastric variceal bleeding. We compared the rebleeding rates and survival times of these modalities.

Methods

The study enrolled 103 patients with suspected gastric variceal bleeding between July 2001 and May 2009. For the management of gastric variceal bleeding, 52 patients underwent EVO; 36, EVL; and 15, BRTO. We evaluated their laboratory results and vital signs, and calculated the Child score, Child classification, and Model for End-stage Liver Disease score. Rebleeding was defined as new-onset hematemesis, hematochezia, melena, or endoscopically proven bleeding. Time-to-rebleeding and survival time were examined by Kaplan-Meyer analysis. A value of p＜0.05 indicated statistical significance.

Results

There were no significant differences in baseline characteristics among the three groups. The overall follow-up period averaged 65.13 months. During follow-up, rebleeding occurred in 17 patients (11 EVO, 5 EVL, and 1 BRTO). The times-to-rebleeding were 63.59, 75.79, and 51.41 months for EVO, EVL, and BRTO, respectively, and did not differ significantly (p=0.515). The median survival times were 77.42, 70.14, and 42.79 months, respectively, and also were not different significantly (p=0.978).

Conclusions

There were no significant differences in the time-to-rebleeding or survival time among EVO, EVL, and BRTO. Further prospective, large-scale studies are needed.

Keywords: Esophageal and gastric varices, Gastrointestinal hemorrhage, Liver cirrhosis, Treatment

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Fig. 1.

Kaplan-Meier plots of time to rebleeding. EVO, endoscopic variceal obliteration; EVL, endoscopic variceal ligation; BRTO, balloon-occluded retrograde transvenous obliteration.

Fig. 2.

Kaplan-Meier plots of time to survival. EVO, endoscopic variceal obliteration; EVL, endoscopic variceal ligation; BRTO, balloon-occluded retrograde transvenous obliteration.

Table 1.

Baseline Characteristics of Patients

		EVO	EVL	BRTO	p-value
Age (mean+SD)		54.75±9.43	53.19±9.62	50.73±9.19	0.33
Gender	Male	41	31	12	0.69
	Female	11	5	3
Etiology of liver cirrhosis	Hepatitis B	20	12	8	0.26
	Hepatitis C	2	3	3
	Alcohol	24	18	3
	Others	6	3	1
Coincidence of HCC	Yes	19	9	7	0.283
	No	33	27	8
Serum albumin (g/dL)		5.95±0.64	3.01±0.53	3.03±0.53	0.775
Serum total bilirubin (mg/dL)		2.51±3.01	3.34±3.90	3.08±2.68	0.084
PT (INR)		1.44±0.32	1.47±0.32	1.45±0.27	0.900
Child Score		9.70±1.93	8.48±2.26	8.20±1.90	0.460
Child-Pugh Classification	Child A	13	9	4	0.990
	Child B	31	21	8
	Child C	8	6	3
MELD score		13.48+6.22	9.18+2.01	9.25+2.49	0.46
Sarin Classification	GOV1	24	18	5	0.46
	GOV2	27	18	9
	IGV1	1	0	1
Form	F1	33	22	3	0.004
	F2	7	8	9
	F3	12	6	3

EVO, Endoscopic variceal obliteration; EVL, endoscopic variceal ligation; BRTO, balloon-occluded retrograde transvenous obliteration; MELD, model for end stage liver disease; HCC, hepatocellular carcinoma.

Table 2.

Analysis of Time to Rebleeding

	Number of patients with rebleeding (%)	Mean time to rebleeding (months)	p-value
EVO	11/52 (21.2)	63.59 (53.42–73.77)	0.515
EVL	5/36 (13.9)	75.79 (63.39–88.19)
BRTO	1/15 (6.7)	51.41 (44.55–58.27)

EVO, endoscopic variceal obliteration; EVL, endoscopic variceal ligation; BRTO, balloon-occluded retrograde transvenous obliteration.

Table 3.

Analysis of Patients' Survival

	Number of expired patients (%)	Mean survival time (months)	p-value
EVO	11/52 (21.2)	77.42 (66.30–88.53)	0.978
EVL	8/36 (22.2)	70.14 (57.19–83.09)
BRTO	3/5 (20)	42.79 (30.57–55.00)

EVO, endoscopic variceal obliteration; EVL, endoscopic variceal ligation; BRTO, balloon-occluded retrograde transvenous obliteration.

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