Endoscopic variceal ligation with multi-band technique for treating upper gastrointestinal hemorrhage

Objective: Esophageal varices (EV) and gastric varices (GV) rupture hemorrhage in advanced cirrhotic patients is a serious medical condition and requires immediate treatment. This clinical study aims to find out a more efficient way of using endoscopic variceal ligation (EVL) in treating variceal bleeding and hypotension caused by upper gastrointestinal hemorrhage, and to compare the long-term therapeutic effect of single-band and multiband ligation techniques. Methods: Sixty-seven patients with clinical diagnosed cirrhosis and massive hematemesis were admitted to hospital through emergency room visits. The blood pressure (Bp) of these patients was between 60-82/30-55 mmHg, and their hemoglobin (Hb) levels were in the range of 50-87 g/L. All patients were given fluid resuscitation and somatostatin or terlipressin to reduce portal vein pressure. Patients with Hb level lower than 60 g/L were also given blood transfusion. When patients’ Bp stabilized at 78-86/50-55 mmHg and Hb reached 55-60 g/L, endoscopic variceal ligation techniques were immediately applied to stop bleeding. Patients were randomly divided into single-band and multi-band ring ligation groups, while some patients accompanying with GV was treated by injecting in the bleeding gastric varices with sequential sclerosing agent, tissue adhesive and sclerosing agent (named as “sandwich” injection therapy). In the multi-bands treatment group, two to four bands were applied on the varices. The number of bands used for varices were dependent on the severity of EV. In another group of patients (single-band group), only one band was used on varices. Results: All sixty-seven patients were found to have EV by gastroscopic examination, and fifty-three of them had accompanying GV. Sixty-six of these sixty-seven cases were rescued successfully by using immediate endoscopic variceal ligation treatment within 24 hours after bleeding. One exception is a patient who still had bleeding even after EVL and sclerotherapy because he had been treated with Sengtaken-Blakemore tube for three days and that might cause erosion and ulcers in his esophagus. Among the thirty-five multi-band ligation treated patients, eight patients’ EV were completely eradicated, and twenty-one patients’ EV were mostly eradicated. Varicose veins disappeared in 82.8% of the multi-band treated patients. In singleband ligation treated group which comprises of thirty two patients, EV were completely eradicated in five patients and EV were mostly eradicated in fourteen patients. Varicose veins disappeared in 59.4% of these single-band treated patients. One-year follow-up results showed that the EV recurrence rate in the multi-bands ligation group was 5.7%, which was significantly lower than the rate of 18.7% in the single-band ligation group. No esophageal stenosis was observed in either groups. Conclusion: Patients with EV and/or GV rupture hemorrhage can be rescued successfully by endoscopic variceal ligation therapy. The long-term efficacy of the multi-band ligation technique is superior to single-band ligation. keywords: Endoscopic variceal ligation, multi-band technique, upper gastrointestinal hemorrhage