To compare the efficacy of different ligation methods in the treatment of acute esophageal variceal bleeding.

A retrospective analysis was performed on the clinical data of 168 patients who underwent emergency endoscopic esophageal variceal ligation (EVL) in the Department of Gastroenterology, the Second Hospital of Tianjin Medical University, between January 2019 and December 2024.According to the ligation method, the patients were divided into targeted ligation group (n=116) and dense ligation group (n=52). The number of ligation points, heart rate and systolic blood pressure at 24 hours postoperatively, rebleeding rates within 72 hours and within 2 weeks, and the incidence of complications were compared between the two groups.

The number of ligation points in the targeted ligation group was significantly lower than that in the dense ligation group (2.3±1.3 vs.10.3±1.4, P<0.01). There were no significant differences in heart rate (68±13 vs. 71±11) or systolic blood pressure (126±15 mmHg vs. 131±12 mmHg) between the two groups at 24 hours after ligation (P>0.05). Within 72 hours after ligation, the rebleeding rate in the targeted ligation group was 0 (0/116), which was significantly lower than 5.8% (3/52) in the dense ligation group (P<0.01). There was no significant difference in the rebleeding rate between the two groups from 72 hours to 2 weeks after ligation (0 vs. 4.1%, P>0.05). No complications such as cardiovascular or cerebrovascular diseases or acute kidney injury occurred within 2 weeks postoperatively in both groups.

For acute esophageal variceal bleeding, targeted ligation has unique advantages for reducing the risk of early rebleeding. The whitening of the ligated variceal ball can be a sign of successful hemostasis.