A new technique of combined endoscopic sclerotherapy and ligation for variceal bleeding

AIM:To develop a technique of combined endoscopicsclerotherapy and ligation (ESL) in which both techniquesof endoscopic sclerotherapy (ES) and endoscopic varicealligation (EVL) can be optimally used.METHODS:ESL was performed in 10 patients (age 46.4±7.9;9 males,1 female) with cirrhosis of liver using sclerotherapyneedle and Speedband,Superview multiple band ligater(Boston Scientific,Microvasive,Watertown,MA).A singleband was placed 5-10 cm proximal to the gastro-esophagealjunction over each varix from proximal to distal margin,followed by intravariceal injection of 1.5% ethoxysclerol(4 ml each) 2 to 3 cm proximal to the gastroesophagealjunction on the ligated varices distal to deployed band.EVLwas then performed at the injection site.Similarly othervarices were also injected and ligated from distal toproximally.In the subsequent sessions,ES alone wasperformed to sclerose small varices at the gastroesophagealjunction.RESULTS:ESL was successfully performed in all patients.A median of 3 (ESL 1,ES 2) sessions (ranged 1-4) wererequired to eradicate the varices in 9 (90%) of 10 patients.Recurrence of varices without bleed was seen in 1 patientduring a mean follow-up of 10.3 months (ranged 6-15).Two patients died of liver failure.None died of varicealbleeding.None of the patients had procedure relatedcomplications.CONCLUSION:ESL may be useful in the fast eradicationof esophageal varices.However,randomised controlled trialsare required to find out its relative efficacy and impact onvariceal recurrence in comparison to ES or EVL.