Effectiveness of Combination of Pharmacological Treatment and Endoscopic Band Ligation in Active Esophageale Varicos Bleeding

Abstract

Acute gastrointestinal system bleeding in cirrhotic patients is one of the emergencies of gastroenterology that requires rapid and careful intervention. For this reason, patients who are thought to have esophageal variceal bleeding should be referred to a center that is adequately equipped for follow-up and treatment. There are studies supporting that current approaches to the treatment of esophageal variceal bleeding have a positive effect on life expectancy. Volume replacement is an important condition in the general approach to esophageal variceal bleeding. It is recommended to maintain hemodynamic stability and keep the hemoglobin level at approximately 8 g/dL. Additionally, it is thought that prophylactic antibiotic usage in gastrointestinal system bleeding of cirrhotic patients reduces the risk of bacterial infection and has a positive effect on life expectancy. In addition to these approaches, there are also specific measures for the control of esophageal variceal bleeding and the prevention of early recurrence of these bleedings. Pharmacological treatment for esophageal variceal bleeding can be started as soon as variceal bleeding is considered, even before upper gastrointestinal system endoscopy. Similar efficacy was demonstrated in a meta-analysis of 15 studies comparing emergency sclerotherapy and pharmacological therapy (vasopressin±nitroglycerin, terlipressin, somatostatin, octreotide). In the treatment of esophageal variceal bleeding, the combination of pharmacological and endoscopic treatment seems to be the most appropriate option. A meta-analysis of 8 studies compared the combination of endoscopic treatment [(sclerotherapy or endoscopic band ligation (EBL)] with endoscopic, pharmacological treatment) for acute variceal bleeding. Combination of endoscopic and pharmacological treatment was found superior in terms of bleeding control and risk of recurrence. In this study, we evaluated the efficacy of combination of pharmacological and endoscopic band ligation in patients who admitted to the hospital with esophageal variceal bleeding.