Title: Comparison of Argon Plasma Coagulation and Paravariceal Injection Sclerotherapy of 1% Polidocanol in Mucosa-Fibrosing Therapy for Esophageal Varices
Abstract: Background:Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are widely used for esophageal varices treatment. However, recurrence of esophageal varices have sometimes been observed after these treatments. In Japan, therefore, in addition to these treatment, a mucosa-fibrosing therapy by paravariceal injection sclerotherapy was performed for complete disappearance of esophageal varices.Aim:This study evaluated the efficacy, complication, recurrence of esophageal varices of mucosa-fibrosing therapy by argon plasma coagulation (APC) compared with those by paravariceal injection sclerotherapy using 1% polidocanol (1% PD). Patients and methods:Sixty-seven patients with F2 or F3 esophageal varices exhibiting the red color sign (high risk group, according to the criteria of the “Japan Society for Portal Hypertension and Esophago-Gastric varices”) were enrolled between March 1999 and March 2003. Twenty-two patients received the mucosa-fibrosing therapy by APC and 45 patients received the mucosa-fibrosing therapy by paravariceal injection sclerotherapy of 1% PD. Eighteen of the 22 patients in the APC group and 39 of the 45 patients in the 1% PD group received prophylactic treatment. All candidates for prophylactic treatment were regarded as being at the high-risk for variceal hemorrhage. Five patients in the APC group and 13 patients in the 1% PD group had concomitant hepatoma. Endoscopic APC (gas flow 1.6 L/min, power setting 50W) was used to promote fibrosis of the esophageal mucosa. We defined recurrence as being greater than F1 or the appearance of red color sign. Result:The number of treatment sessions to eradicate the varices in the APC group was significantly lower than those in the 1% PD group (total:2.3+/-0.7 vs. 2.8+/-0.8, mucosa-fibrosing therapy:1.2+/-0.4 vs. 1.7+/-0.6, p<0.05). According to Kaplan-Meier analysis, the one-and three-year cumulative recurrence-free rate in the APC group (85.2%, 77.5%) were not significantly higher than those in the 1% PD group (81.5%, 71.1%)(Wilcoxon test, p=0.64). Three patients (6.7%) in the 1% PD group developed stricture of esophagus, but there were no other complications detected in the two groups. Conclusions:We concluded that the mucosa-fibrosing therapy with APC is a useful new option for esophageal varices because it is safe and requires less invasion during esophageal varices treatment.
Publication Year: 2004
Publication Date: 2004-04-01
Language: en
Type: article
Indexed In: ['crossref']
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