Introduction:Esophageal varices are defined by an expansion of the parietal veins of the esophagus secondary to portal hypertension. Their rupture is a life-threatening emergency. Rubber band ligation is the main technique for the management of primary and secondary prophylaxis of gastrointestinal bleeding from ruptured VO.
Objectives:The aim of our study is to evaluate the effectiveness of endoscopic ligation in secondary prophylaxis of upper gastrointestinal bleeding by rupture of esophageal varices in our training and deduce results to improve care for our patients.
Material and methods: We conducted a retrospective descriptive study in the gasto-enterology department of CHR AL FARABI OUJDA for a period of 4 years and 6 months (January 2010-June 2014), including all the cases handled in digestive endoscopy unit.
Results:Fifty-six patients were collected, were followed for an average of 30 weeks (range 1-254 weeks), including thirty-four women (60.7%) and twenty-two men (39.3%). The average age of our patients was 48 years (20-90 years). The esophageal varices have been linked to a cirrhotic portal hypertension syndrome of which patients classified Child A and B are 44.4% for each of them, and patients classified Child C are 11.1%. The cirrhosis etiological distribution was: viral cirrhosis in 27% of cases (n=8 HBV, n=4 HVC), alcoholic cirrhosis in 3.6%, only one case of autoimmune cirrhosis, portal vein thrombosis in 21 % (n = 12), cavernoma of the portal vein 7.1% (n = 4) and in 60.7% the causes were not identified. 94.7% of patients presented hemoptysis, which half was associated to melena. Active haemorrhage was notice in 19.6% of cases (n=11), adherent clot in 87.5% of cases. Esophageal varices were classified grade II in 19.6% of cases, grade III 62.5% and grade II, III, 17.9% of cases. Vasoactive treatment was administered to 12 patients, endoscopic ligation was performed either in an emergency or programmed situation. The total number of sessions was 141 with an average number of sessions per patient 2 (1-6 sessions). Immediate hemostasis was achieved in 96% of cases. Rebleeding after ligation was noted in 8.9% of cases (n = 5). The eradication rate of esophageal varices is estimated at 35% (n = 19). We noted two cases of ruptured ulcer.
Conclusion: Ligation is the endoscopic treatment of choice for bleeding from ruptured esophageal varices with low rates of rebleeding and mortality