Addling banding ligation is effective as rescue therapy to prevent variceal rebleeding in haemodynamic non-responders to pharmacological therapy

作者：Gonzalez Antonio; Augustin Salvador^*; Dot Joan; Perez Mercedes; Abu Suboh Monder; Romero Alejandro; Segarra Antoni; Ramon Armengol Josep; Esteban Rafael; Guardia Jaime; Genesca Joan

来源：Digestive and Liver Disease, 2012, 44(1): 55-60.

DOI：10.1016/j.dld.2011.07.019

• Hepatic venous pressure gradient
• Liver cirrhosis
• Pharmacological therapy
• Portal hypertension
• Variceal haemorrhage

Background: It is unknown which is the best therapy to treat haemodynamic non-responders to pharmacological therapy after variceal bleeding. %26lt;br%26gt;Aim: To evaluate the efficacy of adding banding ligation to drugs to prevent variceal rebleeding in haemodynamic non-responders to drugs. %26lt;br%26gt;Methods: Fifty-three cirrhotic patients with variceal bleeding underwent a hepatic venous pressure gradient (HVPG) measurement 5 days after the episode. Nadolol and nitrates were then titrated to maximum tolerated doses. A second HVPG was taken 14 days later. Responders (HVPG %26lt;= 12 mm Hg or %26gt;= 20% decrease from baseline) were maintained on drugs and non-responders had banding ligation added to drugs. %26lt;br%26gt;Results: Mean follow-up was 28 months. In 5 patients the second HVPG could not be performed because of early rebleeding. The remaining 48 patients were classified as responders (n = 24) and non-responders (n = 24), who had banding added. No baseline differences were observed between groups. Variceal rebleeding occurred in 12% of the 48 patients whose haemodynamic response was assessed. Responders on drug therapy presented a 16% rebleeding rate, whilst non-responders rescued with banding showed an 8% rebleeding rate. Rebleeding-related mortality was not different between groups. %26lt;br%26gt;Conclusion: In a HVPG-guided strategy, adding banding ligation to drugs is an effective rescue strategy to prevent rebleeding in haemodynamic non-responders to drug therapy.

• 出版日期2012-1