Comparación de la efectividad de la ligadura vs la esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: Estudio de cohortes comparativas.

Resumen

COMPARISON OF BAND LIGATION WITH SCLEROTHERAPY FOR THE TREATMEN OF BLEEDING ESOPHAGEAL VARICES

Background: Endoscopic band ligation is the treatment of choice for bleeding esophageal varices. However it is not clear if this procedure is associated with less early and late mortality than sclerotherapy.   Aim: To assess rates of  re-bleeding and mortality in cohorts of patients with bleeding esophageal varices treated with endoscopic injection or band ligation. Patients and methods: Analysis of medical records and endoscopy reports of two cohorts of patients with bleeding esophageal varices, treated between 1990 and 2010. Of these, 54 patients were treated with sclerotherapy and 90 patients with band ligation. A third cohort of 116 patients that did not require endoscopic treatment, was included. The mean analyzed follow up period was 2.5 years (range 1-16)  Collection of data was retrospective for patients treated with sclerotherapy and prospective  for patients treated with band ligation. Rates of re-bleeding and medium term mortality were assessed.  Results: During the month ensuing the first endoscopic treatment, re-bleeding was recorded in 72 and 39% of patients treated with band ligation and sclerotherapy, respectively (p< 0.01). The relative risk of bleeding after band ligation was 0.53 ( 95% confidence limits 0.39-0.73). Death rates until the end of follow up were 48 and 20% among patients with  treated with band ligation and sclerotherapy, respectively (p< 0.01), with a relative risk of dying for patients subjected to band ligation of 0.41 (95% confidence limits 0.25-0.68). Conclusions: Band ligation was associated with lower rates of re-bleeding and mortality in these cohorts of patients.