Endoscopic variceal ligation combined with Hassab's procedure in preventing the recurrence of esophageal varices

Abstract

Objective: To assess the efficacy of endoscopic variceal ligation (EVL) combined with Hassab's procedure in the prevention of variceal recurrence.

Methods: One hundred and thirty-five patients with esophageal varices were randomized to receive EVL alone, Hassab's procedure alone or a combination of EVL and Hassab's procedure for variceal eradication. Ultrasonographic venous network images were recorded by an esophageal microprobe before and after the EVL or Hassab's procedure. The clinical outcome and vascular network images of the 3 groups were analyzed.

Results: Esophageal varices were obliterated immediately after EVL alone, while both perforating veins and periesophageal collaterals remained patent, and 83% had recurrence of esophageal varices during an initial 3-year follow-up. Esophageal varices were reduced in size, periesophageal collaterals were obliterated after Hassab's procedure alone, and 30% experienced rebleeding and 95% with variceal recurrence. EVL combined with Hassab's procedure obliterated all esophageal varices, perforating veins and periesophageal collaterals, and only 3 patients (8%) recurred.

Conclusion: The existence of patent perforating veins and periesophageal collaterals is the reason of esophageal variceal recurrence after EVL alone. EVL combined with Hassab's procedure can effectively prevent the recurrence, even if the cirrhojtic portal hypertension persisted.