Modified ‘sandwich’ injection with or without ligation for variceal bleeding in patients with both esophageal and gastric varices: a retrospective cohort study

Abstract

Objectives

Esophagogastric variceal bleeding (EGVB) is a serious disease with high mortality. Endoscopic therapy has long been shown to be effective but the optimum technique is still unclear. We aimed to investigate the efficacy, safety and predictive factors of 1-year rebleeding of modified ‘sandwich’ injection combined with esophageal variceal ligation (EVL) for treating EGVB.

Methods

A retrospective analysis was performed of 100 patients with EGVB who underwent modified ‘sandwich’ injection with or without EVL (EVL + and EVL – group). Patient follow-up was 1 year. Outcomes such as control of bleeding, rebleeding, complication rate and mortality were compared. Further, prognostic factors for rebleeding at one year were estimated.

Results

No significant differences between two groups regarding initial bleeding control, complications, 6-week rebleeding or mortality in 1-year were observed. Rebleeding rate at 1-year of EVL – group was significantly higher than EVL + group (40 vs 20%, p = .029). Independent predictors of rebleeding at 1-year were gender, bilirubin and whether EVL was combined with injection.

Conclusions

Based on this single-center retrospective study, both of the two kinds therapies appeared to have relatively favorable outcomes. With respect to the rebleeding rate at 1-year, modified ‘sandwich’ injection combined with EVL may be superior to modified ‘sandwich’ injection alone.

Keywords:

• Esophagogastric variceal bleeding
• ligation
• modified ‘sandwich’ injection
• predictor
• rebleeding

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [grant number 81770585]; National Science and Technology Major Project of China [grant numbers 2017ZX10202201, 2017ZX10203201 and 2018ZX10725506-001].