Efficiency and Safety of Endoscopic Injection Sclerotherapy With Ligation for Esophageal Varices: A Retrospective Study.
EISL appears to require less time and may have fewer adverse events compared to conventional EIS, but further research is needed to confirm these benefits.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This study compared the efficacy of endoscopic injection sclerotherapy (EIS) and endoscopic injection sclerotherapy with ligation (EISL) in treating esophageal varices. A total of 148 cases were analyzed, with 104 receiving EIS and 44 receiving EISL. EISL showed shorter procedure times and fewer adverse events compared to EIS.
Abstract
Objectives Endoscopic injection sclerotherapy with ligation (EISL) is a combined endoscopic treatment that involves endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation. This study aimed to compare the efficacy of conventional EIS and EISL in treating esophageal varices and the usefulness of EISL. Methods A total of 104 cases treated with conventional EIS and 44 cases treated with EISL for esophageal varices were included in the study. The procedure duration, intra-injection volume, and para-injection volume, the success rate of intravascular injection based on variceal type, recurrence-free survival, and post-treatment adverse events were assessed. Results The procedure duration was significantly shorter in the EISL group (13.1 ± 7.2 min) than in the conventional EIS group (20.7 ± 8.0 min; p < 0.0001). Additionally, the para-injection volume per session was lower in the EISL group (0.7 ± 1.0 mL) than in the conventional EIS group (1.2 ± 1.1 mL; p = 0.0426). The intravascular injection success rate was higher in the EISL group for all variceal morphologies, particularly for F1/F2 esophageal varices. In terms of post-treatment adverse events, the frequency of fever was lower in the EISL group than in the conventional EIS group (p = 0.008). There was no significant difference in recurrence-free survival between the conventional EIS and EISL groups. Conclusions Compared with conventional EIS, EISL required shorter procedure times and reduced paravariceal leakage of the injected sclerosant. EISL also demonstrated higher success rates, particularly for small varices, and fewer post-treatment adverse events.
Background
This paper addresses the clinical question of the comparative efficacy of endoscopic injection sclerotherapy (EIS) and endoscopic injection sclerotherapy with ligation (EISL) in treating esophageal varices. Previous studies have indicated varying success rates and complications associated with these procedures, but a direct comparison has not been extensively documented. Understanding the differences in outcomes between these two methods is crucial for clinical decision-making in managing esophageal varices.
Methods
The study employed a retrospective design, analyzing 148 cases of esophageal varices, with 104 treated using conventional EIS and 44 treated with EISL. The primary outcome measures included procedure duration, intra-injection volume, para-injection volume, success rate of intravascular injection, recurrence-free survival, and post-treatment adverse events. No specific details on the duration of follow-up were reported.
Results
The primary endpoint showed that the procedure duration was significantly shorter in the EISL group, with a mean of 13.1 ± 7.2 minutes compared to 20.7 ± 8.0 minutes in the conventional EIS group (p < 0.0001). Additionally, the para-injection volume was lower in the EISL group at 0.7 ± 1.0 mL versus 1.2 ± 1.1 mL in the EIS group (p = 0.0426). The study also reported a higher success rate for intravascular injection in the EISL group, particularly for F1/F2 varices, and a lower frequency of fever as a post-treatment adverse event (p = 0.008). However, there was no significant difference in recurrence-free survival between the two groups.
Interpretation
The findings suggest that EISL may offer advantages over conventional EIS, particularly in terms of procedure duration and reduced adverse events. However, while the statistical significance of the results is clear, the clinical significance, especially regarding the success rates and recurrence-free survival, requires further investigation. The small sample size for the EISL group and the retrospective nature of the study limit the strength of the conclusions drawn, indicating a need for larger, randomized controlled trials to confirm these findings.
Key findings
- Procedure duration: 13.1 ± 7.2 min for EISL vs 20.7 ± 8.0 min for EIS, p < 0.0001.
- Para-injection volume: 0.7 ± 1.0 mL for EISL vs 1.2 ± 1.1 mL for EIS, p = 0.0426.
- Intravascular injection success rate higher in EISL for all variceal morphologies.
- Frequency of fever: lower in EISL group, p = 0.008.
- No significant difference in recurrence-free survival between EIS and EISL groups.
Limitations
- Retrospective study design.
- Small sample size for EISL group (n=44).
- No randomization, potential for bias.
- Lack of detailed follow-up duration reported.