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Randomized Controlled Trial
. 2022 Oct;36(10):7839-7847.
doi: 10.1007/s00464-022-09412-6. Epub 2022 Jul 25.

Novel balloon compression-assisted endoscopic injection sclerotherapy and endoscopic variceal ligation in the treatment of esophageal varices: a prospective randomized study

Qianqian Zhang #  1 , Jing Jin #  1 , Fumin Zhang #  1 , Yi Xiang #  1 , Wenyue Wu  1 , ZeXue Wang  1 , Derun Kong  2   3
Affiliations
Randomized Controlled Trial

Novel balloon compression-assisted endoscopic injection sclerotherapy and endoscopic variceal ligation in the treatment of esophageal varices: a prospective randomized study

Qianqian Zhang et al. Surg Endosc. 2022 Oct.

Abstract

Background: Herein, our group designed a novel technology, termed balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS), which was applied to improve the efficiency of eradicating esophageal varices (EVs). The present study aimed to compare the rate of eradication and efficacy between bc-EIS and endoscopic variceal ligation (EVL) in the management of EVs.

Methods: Ninety-five patients with esophageal variceal bleeding (EVB) were randomly assigned to receive bc-EIS or ligation alone. Additional treatment sessions were held 1 month later and then at 3-month intervals until eradication of the varices was achieved. Endoscopic follow-up examinations were carried out at 6-month intervals in the absence of recurrence or immediately if there was any recurrent bleeding.

Results: The mean physical injection points per session were 2.89 ± 0.79, and the mean volume of lauromacrogol used per session was 17.74 ± 7.09 ml in the bc-EIS group. The mean band per session was 6.13 ± 0.86. The rate of eradication after one to three rounds of bc-EIS was obviously higher than that of the EVL group (89.36%, 97.87%, and 100% vs. 37.5%, 43.75%, and 47.92%, respectively). Retrosternal pain or discomfort in the bc-EIS group was slightly lower than that in the EVL group (23.4%, 11/47 vs. 31.25%, 15/48). Two and five patients showed mild abdominal bloating and distension between the bc-EIS and EVL groups, respectively (2/47, 4.26% vs. 5/48, 10.42% P > 0.05). Nausea and vomiting were reported in one patient (1/47, 2.13%) in the bc-EIS group and three patients (3/48, 6.25%) in the EVL group. However, there were no statistically significant differences between the two groups (P > 0.05). No fatal or severe complications, such as esophageal perforation, esophageal stricture or ectopic embolism, were observed.

Conclusion: The bc-EIS method was effective in eradicating EVs and was accompanied by fewer complications.

Keywords: Balloon compression-assisted endoscopic injection sclerotherapy; Cirrhosis; Endoscopic injection sclerotherapy; Endoscopic variceal ligation; Esophageal variceal bleeding; Esophageal varices.

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Conflict of interest statement

Qianqian Zhang, Jing Jin, Fumin Zhang, Yi Xiang, Wenyue Wu, Zexue Wang, and Derun Kong have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
The initial outer diameter of the balloon was 1.3 cm, which could expand to a maximum of 4 cm after inflation with 30 ml air
Fig. 2
Fig. 2
a The lubricated endoscope together with the deflated balloon and the transparent cap were inserted into the lumen of the oesophagus. b The varicose veins could be fully compressed by the inflated balloon, a disposable endoscopic injection needle was introduced through the operation channel and injected into the base of the variceal columns near the cardia
Fig. 3
Fig. 3
a Blood flowed back into the needle. b Lauromacrogol was administered intravaliceally, which was mixed with methylthioninium chloride as tracers. c The injection point was compressed by a needle sheath or transparent cap. d The esophageal varicose vein disappeared after treatment
See this image and copyright information in PMC

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