Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

Table 1 Number of banding procedures and time to eradication of varices

Child-Pughgrade	Number of patients	Survival > 90 d	Numbereradicated	Number of banding proceduresmedian (range)	Months to eradicatemedian (range)	Number recurred
A	n = 32	32	15	3 (1-13)	15 (1-55)	9
B	n = 48	44	18	2 (1-12)	4 (1-29)	12
C	n = 60	35	17	2 (1-5)	3 (1-47)	10
Total	n = 140	111	50	2 (1-13)	5 (1-55)	13

Table 2 Rebleeding after index admission in 120 surviving patients

	Overall bleeding from all sources		Bleeding from esophageal varices
	Patients	Bleeding events	Patients	Bleeding events
< 6 mo	16 (13.3%)	22	10 (8.3%)	16
6-12 mo	21 (17.5%)	28	15 (12.5%)	20
1-2 yr	25 (20.8%)	30	15 (12.5%)	20
> 2 yr	26 (21.7%)	31	16 (13.3%)	21
Overall	26 (21.7%)	31	16 (13.3%)	21

Table 3 Cumulative survival by Child-Pugh grade, n (%)

Child-Pugh Grade	Number of patients	1-yr survival	3-yr survival	5-yr survival	10-yr survival
A	n = 32	30 (93.7)	29 (90.6)	29 (90.6)	25 (78.1)
B	n = 48	40 (83.3)	36(75)	34 (70.8)	31 (64.5)
C	n = 60	30 (50)	26 (43.3)	21 (35)	17 (28.3)

Table 4 Specific risk factors for rebleeding on multivariate analysis

	Total, n = 140	No rebleeding, n = 104	Rebleeding, n = 36	P value
Age				0.149
20-39 yr	36	30	6
40-59 yr	74	50	24
> 60 yr	30	24	6
Gender				0.112
Male	100	78	22
Female	40	26	14
Child-Pugh grade				0.965
A	32	24	8
B	48	35	13
C	60	45	15
Cause of varices				0.343
Alcoholic	84	60	24
Non-Alcoholic	56	44	12

Table 5 Updated summary of published randomized controlled trials of endoscopic variceal ligation vs injection sclerotherapy

Ref.	Year	Number of patients	Number in each group		Control of bleeding		Varices eradicated		Eradication sessions		Rebleeding		Major complications		Variceal recurrence		Survival
			EVL	IST	EVL	IST	EVL	IST	EVL	IST	EVL	IST	EVL	IST	EVL	IST	EVL	IST
Stiegmann et al[21]	1992	129	64	65	86%	77%	55%	56%	4	5	36%	48%	2%	22%	33%	50%	72%	55%
Laine et al[22]	1993	77	38	39	89%	89%	59%	69%	4.1	6.2	24%	31%	24%	56%	-	-	89%	85%
Gimson et al[23]	1993	103	54	49	91%	92%	82%	71%	3.4	4.9	30%	53%	69%	65%	-	-	52%	18%
Lo et al[24]	1995	120	61	59	94%	80%	74%	63%	3.8	6.5	11%	36%	3.3%	19%	-	-	84%	68%
Hou et al[25]	1995	134	67	67	100%	88%	87%	79%	3.5	4.6	18%	33%	4%	22%	48%	30%	79%	84%
Sarin et al[26]	1997	95	47	48	86%	80%	94%	94%	4.1	5.2	6.4%	20.8%	45%	50%	28.7%	7.5%	93%	89%
Baroncini et al[27]	1997	111	57	54	-	-	93%	93%	3.5	4.0	16%	19%	11%	31%	30%	13%	79%	78%
Avgerinos et al[28]	1997	77	37	40	-	-	95%	98%	3.7	5.8	27%	48%	35%	60%	31%	44%	80%	79%
Lo et al[19]	1997	71	37	34	97%	76%	-	-	-	-	17%	33%	5%	29%	-	-	81%	65%
Siqueira et al[29]	1998	40	20	20	-	-	90%	100%	3.1	3.7	0%	5%	-	-	0%	0%	100%	95%
De la Pena et al[30]	1999	88	42	46	-	-	79%	71%	5.3	6.6	31%	50%	14%	41%	47%	23%	81%	78%
Masci et al[31]	1999	100	50	50	-	-	88%	82%	3.4	5.3	12%	42%	18%	38%	32%	27%	80%	78%
Fakhry et al[32]	2000	84	43	41	94%	94%	-	-	2.8	4.8	16%	15%	2%	65%	21%	20%	93%	93%
Zargar et al[33]	2005	73	37	36	100%	83%	95%	92%	3.7	7.7	3%	19%	3%	22%	11%	9%	-	-
Villanueva et al[20]	2006	179	90	89	96%	85%	-	-	-	-	7%	12%	4%	13%	-	-	87%	79%
Luz et al[34]	2011	100	50	50	92%	96%	-	-	-	-	22%	14%	-	-	-	-	77%	80%
Ali et al[35]	2017	124	60	64	100%	100%	87%	80%	-	-	23%	28%	10%	27%	-	-	78%	72%

EVL: Endoscopic variceal ligation; IST: Injection sclerotherapy. Bold color highlighted comparisons are significant, P < 0.05.