Gut and Gastroenterology

Abstract

Medical Versus Endoscopic Treatment of Oesophageal Varices in Liver Cirrhosis

Author(s): Hanno AF,Aboelkheir HF, Alwazzan DA, Abdelrahman MI

Introduction: Portal hypertension is the most common complication of liver cirrhosis. It may be complicated by gastrointestinal bleeding from oesophageal or gastric varices. Treatment of varices can be medical by using non-selective beta blockers (as propranolol or cavedilol), or endoscopic (endoscopic variceal ligation EVL, endoscopic injection sclerotherapy EIS), or both. 
Aims & Methods: This study was conducted on 80 patients with liver cirrhosis and oesophageal varices (O.V.) grade III and IV, who were classified into five groups. Group I, 20 patients were subjected to EVL alone, group II, 20 patients received carvedilol alone(6.25 mg once daily, then increased to 6.25 mg twice daily after 1 week), group III received propranolol alone (20 mg three times daily), group IV, 20 patients who were subjected to EVL combined with carvidolol (6.25 mg once daily, then increased to 6.25 mg twice daily after 1 week)and group V, 20 patients who were subjected to EVL combined with propranolol(20 mg three times daily). All patients were followed up by doppler study of portal vein and upper G.I. endoscopy. 
Results: Upper G.I. endoscopy was done for all patients every 3 months up to 12 months. In the 1st visit, 95% of group I patients had O.V. grade IV and 5% had grade III O.V., by the 4th visit 80% had O.V. grade I and 20% had no O.V. in the same group. In group II, in the 1st visit 90% of patients had O.V. grade IV and 10% had O.V. grade III, in the 4th visit 60% had O.V. grade I and 40% had no O.V., In group III, in the 1st visit 95% of patients had O.V. grade IV and 5% had O.V. grade III, in the 4th visit 50% had O.V. grade I and 30% had no O.V., In group IV, in the 1st visit 20% of patients had O.V. grade IV and 80% had O.V. grade III, in the 4th visit 40% had O.V. grade I and 60% had no O.V., regarding group V, in the 1st visit, 75% had grade IV O.V. and 5% had O.V. grade III, while in the 4th visit 60% had O.V. grade I and 40% had no varices.

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