A Randomized Control Trial of Bi-Monthly Versus Bi-Weekly Endoscopic Variceal Ligation of Esophageal Varices

Abstract

Endoscopic variceal ligation (EVL) is a safe and simple procedure now being used on a widening scale. Yet most patients who undergo endoscopic treatment for esophageal varices eventually require additional treatment for recurrent varices. In this study, we investigated and compared the efficacy and long-term results of EVL performed in three treatments with a total of sixteen O-rings at two different intervals; bi-weekly (once every 2 wk: the conventional interval) and bi-monthly (once every 2 months). A total of 63 patients with esophageal varices were randomly assigned to groups receiving bi-weekly or bi-monthly EVL treatment. Optimal medical therapy was assessed by one medical doctor who was unaware of the patients' treatment assignments. Three parameters of treatment outcome were evaluated: the rate of recurrence, rate of additional treatment, and overall survival. The overall rates of variceal recurrence and additional treatment were both higher in the bi-weekly group than in the bi-monthly group (p < 0.001). In conclusion, EVL performed for the treatment of esophageal varices at bi-monthly intervals brought about better results than the same treatment performed at bi-weekly intervals. The treatments intercalated by the longer interval obtained a higher total eradication rate, lower recurrence rate, and lower rate of additional treatment.