Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding

Objective To compare the efficiency of percutaneous transhepatic variceal embolization (PTVE) plus endoscopic variceal ligation (EVL) with EVL alone in the treatment of esophageal variceal bleeding. Methods Cirrhotic patients with recent esophageal variceal bleeding from January 2007 to December 2011 were collected and assigned to PTVE+EVL (N=41) or EVL (N=47) groups. We performed chart reviews and prospective follow-up to determine variceal rebleeding, recurrence of varices and survival. Results During the follow-up period, recurrence of esophageal varices (EV) occurred in 8 patients (19.5%) in the PTVE+EVL group and 23 (48.9%) in the EVL group (P=0.004). The time to recurrence of EV was 9.2 +/- 2.7 months and 4.9 +/- 2.1 months, respectively. Three patients (7.3%) in the PTVE+EVL group and 12 (25.5%) in the EVL group experienced rebleeding from all sources (P = 0.023). One patient (2.4%) in the PTVE+EVL group and 7 (14.9%) in the EVL group experienced rebleeding from EV (P = 0.024). Multivariate Cox analysis indicated that the treatment method was the only predictor of rebleeding. There was no significant difference in the survival rate between the two groups. Conclusion With adequate and permanent obliteration of EV and their feeding veins, the combination of PTVE with cyanoacrylate and EVL is more effective than EVL alone in the prevention and treatment of EV recurrence and rebleeding.