Endoscopic obliteration of varices

There are several ways of doing this, including intravariceal injection of sclerosing agents, ligation of varices with rubber bands, clipping, and various combinations of these techniques. Each method requires several sessions, and the percentage of full obliteration is variable. Both sclerosing and ligation lead to esophageal ulcerations around the varix. These are usually smaller and are less likely to lead to esophageal stenosis after ligation than after sclerosis. Portal hypertensive gastropathy, i.e. engorgement with predisposition of gastric mucosa to bleed, may occur spontaneously in patients with portal hypertension, and is aggravated by courses of variceal sclerosis but not after variceal ligation. A meta-analysis of seven studies comparing sclerotherapy with ligation has shown that ligation is superior by leading to lower recurrences of bleeding, lower mortality, fewer complications, and fewer treatment sessions ( Laine.and.Cook.1995). Another study has shown that ligation of varices compares favorably with variceal clipping ( Koutsomanis ei a/ 1995).

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