A comparative study of esophageal varices – Banding Vs Sclerotherapy.

Naveen, M (2016) A comparative study of esophageal varices – Banding Vs Sclerotherapy. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION: Esophageal varices are Porto systemic collaterals that link between Porto venous and Systemic venous circulations.They are formed due to portal hypertension (a progressivecomplication of cirrhosis), at the sub mucosa of the lower esophagus.Rupture and bleeding of esophageal varices are the major complications of portal hypertension and are associated with a high mortality rate.Variceal bleeding accounts for 15-35% of all cases of upper gastrointestinal bleeding.Patient with variceal bleeding who had no treatment,the risk ofrebleeding is 50%.The presence of esophageal varices correlates with the severity of the liver disease.Endoscopic modalities used for treatment are endoscopic slerotherapy and band ligation for treatment of acute bleeding and secondary prophylaxis. AIM AND OBJECTIVES: To compare the efficacy and safety of endoscopic variceal band ligation and sclerotherapy in the management of variceal bleeding due to portal hypertension. MATERIALS AND METHODS: The study was conducted in the Department of General Surgery in collaboration with the Department of Medical Gastroenterology and Department of Vascular Surgery, Coimbatore medical College Hospital from June 2013- August 2015. This study was approved by the ethical committee of Coimbatore Medical College Hospital. Study Population: 50 patients with portal hypertension who were admitted during the study period of June 2013 - august 2015 in medicine and surgery wards, with the complaints of hematemesis and/or malena, who had grade 3 and 4 varices without gastric varices and other causes of upper GI bleeding in upper GI endoscopy were included in this study. Randomisation: Every alternative patients presenting with above history is divided into 2 groups. One group is treated with esophageal banding and other group is treated with 3 % Sodium tetradecyl sulphate after getting informed and written consent from the patient. Inclusion Criteria: Age 21-70 years, Both sexes, Grade III and IV esophageal varices, Patients complaining with hematemesis and/or malena, Due to Portal Hypertension. Exclusion Criteria: Age <21 and >70, Grade I and II varices, Non portal hypertension causes of upper GI bleeding, Prior history of endoscopic treatment and shunt operation for Varices, Presence of Hepatic Encephalopathy, Hepatorenal syndrome and life expectancy less than 48 hours, Patients with positive serology for Hepatitis B (HbsAg) and C virus (anti HCV). CONCLUSION: Both banding and 3% sodium tetradecyl sulphate are equally effective in controlling acute variceal hemorrhage among which sclerotherapy had a small advantage and also in preventing rebleeding. Both banding and sclerotherapy are effective in eradicating varices but banding is more efficacious Both banding and sclerotherapy have their side effects but sclerotherapy has more frequent and dreaded complications. Hence banding is superior to sclerotherapy both in efficacy and Safety.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Esophageal Varices ; Banding ; Sclerotherapy.
Subjects: MEDICAL > General Surgery
Depositing User: Punitha K
Date Deposited: 31 Jul 2017 09:48
Last Modified: 18 Oct 2017 05:46
URI: http://repository-tnmgrmu.ac.in/id/eprint/2388

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