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Korean J Gastroenterol  <  Volume 72(4); 2018 <  Articles

The Korean Journal of Gastroenterology 2018; 72(4): 188-196  https://doi.org/10.4166/kjg.2018.72.4.188
Risk Factors and On-site Rescue Treatments for Endoscopic Variceal Ligation Failure
Dong Hyun Kim, Eunae Cho, Chung Hwan Jun , Dong Jun Son, Myeon Jae Lee, Chang Hwan Park, Sung Bum Cho, Seon-Young Park, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
Correspondence to: Chung Hwan Jun
Received: September 6, 2018; Revised: October 9, 2018; Accepted: October 10, 2018; Published online: October 25, 2018.
© The Korean Journal of Gastroenterology. All rights reserved.

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: The success rate of endoscopic variceal ligation (EVL) is about 85-94%. There is only a few studies attempting to determine the cause of EVL failure, and to date, on-site rescue treatments remains unestablished. This study aimed to elucidate the risk factors for EVL failure and the effectiveness of on-site rescue treatment.
Methods: Data of 454 patients who underwent emergency EVL at Chonnam National University Hospital were retrospectively analyzed. Enrolled patients were divided into two groups: the EVL success and EVL failure groups. EVL failures were defined as inability to ligate the varices due to poor endoscopic visual field, or failure of hemostasis after band ligation for the culprit lesion.
Results: Forty-seven patients experienced EVL failure. In the multivariate analysis, male patients, initial hypovolemic shock, active bleeding on endoscopy, and history of previous EVL were independent risk factors for EVL failure. During endoscopic procedure, we came across the common causes of EVL failure, including unsuctioned varix due to previous EVL-induced scars followed by insufficient ligation of the stigmata and inability to ligate the varix due to poor endoscopic visual field. Endoscopic variceal obturation using N-butyl-2-cyanoacrylate (48.9%) was the most commonly used on-site rescue treatment method, followed by insertion of Sangstaken Blakemore tube (14.9%), and EVL retrial (12.8%). The rescue treatments successfully achieved hemostasis in 91.7% of those in the EVL failure group.
Conclusions: The risk factors of EVL failure should be considered before performing EVL, and in case of such scenario, on-site rescue treatment is needed.
Keywords: Esophageal and gastric varices; Treatment failure; Salvage therapy


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