Abstract:

Objective

To compare the therapeutic efficacy of modified endoscopic variceal ligation targetinghigh-risk bleeding sites with conventional ligation methods in patients with cirrhosis-related esophageal varices.

Methods

Prospectively collected 69 patients diagnosed with cirrhosis-related esophageal varices and scheduled for their first EVL from March 2022 to March 2023 at the First Medical Center of Chinese PLA General Hospital were included in the modified lower-middle segment ligation group.Retrospectively collected 271 patients diagnosed with cirrhosis-related esophageal varices and who had undergone their first EVL from February 2018 to February 2022 at the same center were included in the conventional lower segment ligation group. After propensity score matching， the therapeutic effects， adverse events， and other indicators during and after EVL were compared between the two groups. Patients were followed up for 12 months， and the intention-to-treat analysis and Kaplan-Meier method were used to focus on patient survival issues， along with the per-protocol analysis.

Results

After propensity score matching，the baseline data of the two groups were comparable. The number of detached rings during the procedure and the postoperative chest pain VAS scores in the lower-middle segment ligation group were higher than those in the lower segment ligation group， with statistically significant differences （P＜0. 05）. In the intention-totreat （ITT） analysis at the 6-month follow-up， the recurrence-free survival rate of esophageal varices in the lower-middle segment ligation group was greater than that in the lower segment ligation group， with statistically significant differences （P＜0.05）. In the per-protocol （PP） analysis， the esophageal varices recurrence rate at 6 months and the bleeding rate at 12 months in the lower-middle segment ligation group were both lower than those in the lower segment ligation group， with a longer average time to recurrence， and all with statistically significant differences （P ＜0. 05）.

Conclusion

In patients with cirrhosis-related esophageal varices， the modified endoscopic variceal ligation （EVL） targeting high-risk bleeding sites is safe and effective. It extends the time to recurrence and reduces the recurrence rate at 6 months and the bleeding rate at 12 months compared to the conventional ligation method.

Key words: Esophageal varices, Endoscopic treatment, Modified endoscopic variceal ligation