Abstract

ENDOSCOPIC VARICEAL LIGATION VERSUS ENDOSCOPIC INJECTION SCLEROTHERAPY FOR MANAGEMENT OF ESOPHAGEAL VARICEAL HEMORRHAGE: A META-ANALYSIS

Wafa Mohsen Badauod*, Ahmed Abdulaziz Alshehri, Naif Ahmed Alhazmi, Omar Faisal Alfarhan, Najd Saleh Alolayan, Jamal Suliman Alabdli, Muteb Abdullah Aldajam, Dhafer Mohammed Alahmari, Faisal Ali Hamoudah

Abstract

Background and Purpose: The Sclerotherapy has verified to be not so good as band ligation for primary and secondary prophylaxes of variceal hemorrhage, because of a better variety of complications, and the fact that greater classes are required to achieve variceal obliteration. but, endoscopic SCL has still been found to be much like BL for manage of bleeding in some research. The Aim of this work is to provide cumulative data about the safety of (EVL) Endoscopic Variceal Ligation compared with (EIS) Endoscopic Injection Sclerotherapy for treatment of esophageal variceal hemorrhage. Methods: A systematic search was performed of PubMed, Cochrane library Ovid, Scopus & Google scholar to identify internal medicine RCTs, clinical trials, and comparative studies, which studied the outcome of EVL versus EIS of Esophageal Variceal Hemorrhage (EVH) patients. A meta-analysis was done using fixed and random-effect methods. The primary outcome of interest was post-operative re-bleeding. Secondary outcome was post-operative mortality. Results: A total of 5 studies were identified involving 450 patients, 223 in the EVL and 227 in the EIS. Regarding primary outcome measure, fixed-effects model of the meta-analysis study showed significant increase in post-operative re-bleeding in EVL compared to EIS (p < 0.05). Regarding secondary outcome measure, fixed-effects model of the meta-analysis study showed non- significant difference in post-operative mortality between the 2 groups (p > 0.05). Conclusion: To conclude, EVL is slightly better than EIS in terms of the lower rates of rebleeding, complications, and the higher rate of variceal eradication, but no difference regarding mortality rate. Therefore, EVL is the first choice for esophageal variceal bleeding.

Keywords: Endoscopic variceal ligation, endoscopic injection sclerotherapy, esophageal variceal hemorrhage.