Potentials of Endoscopic Combined Treatment of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis

Background. Treatment of variceal esophageal-gastric bleeding in patients with portal hypertension is an acute challenge in urgent surgery. 
The aim of study was to develop a technique and evaluate the immediate and long-term effectiveness of endoscopic ligation (EL) with the use of cytoprotective treatment. 
Materials and methods. The study included 106 patients who were treated at the City Clinical Emergency Hospital No. 1, Voronezh, Russia. The main group consisted of 54 patients who were treated using a developed technique of combined endoscopic ligation of esophageal varices combined with the polymer alginate hemostatic sorbent (PAHS) application on ligated nodes and post-ligature defects. The comparison group consisted of 52 patients who underwent endoscopic ligation without PAHS application. 
Results. In the main group, total hemostasis was achieved in 52 of 54 (96.3%) patients, p = 0.027; recurrent bleeding was observed in 2-3 days after combined ligation in two (3.7%) patients. No operations were performed; two (3.7%) patients died in this group. In the comparison group, total hemostasis was achieved in 43 of 52 (82.6%) patients, p=0.027. Recurrent bleeding was observed in nine (17.3%) patients. In the comparison group, one (1.9%) patient with massive bleeding was operated on, and seven (13.5%) patients died. 
Conclusion.  Endoscopic ligation combined with cytoprotective treatment using a polymer alginate hemostatic sorbent increases the effectiveness of local hemostasis and reduces the rate of recurrent hemorrhage from 17.3% to 3.7%, p = 0.027. Insufflation of PAHS onto ligature nodes and defects helps relieve pain, accelerates the processes of postligature defect epitheliation from 7.7% to 94.4%, p=0.0001; it also prolongates the remission of the underlying disease.