Endoscopic variceal banding - as a modality to improve quality of life of cirrhotic patients

Abstract

Introduction: The prevalence of varices in patients with cirrhosis is approximately 50%, 2/3 are at high risk of developing variceal bleeding, in 30% of cases bleeding occurs. Mortality rates from the first bleeding episode are estimated to range from 30% to 50%. The risk of rebleeding is 70% in following 2 years with a mortality rate of 30%. Nowadays, modern endoscopy created new possibilities for effective treatment of both bleeding and nonbleeding varices. Therefore, researching quality of life (QL) is an actual issue, besides improving it in patients with liver deficiency became a necessary condition in medical practice. Identifying the effect of endoscopic variceal banding (EVB) on disease evolution and QL in patients with chronic liver disease. Materials and methods: This study consists of 53 patients with established diagnosis of viral liver cirrhosis and esophageal varices (EV) with high risk of bleeding. All patients had undergone endoscopic prophylactic eradication of EV in nonbleeding state using EBV. Additionally, the SF-36 score was used to evaluate the post-treatment QL, which consist of 36 questions and a broad spectrum of activity. Results: There were 19 men and 34 women with a mean age of 45.1 years. According to the Child's classification, 22 patients were in Child's B and 31 in Child's C. Vast majority of patients (84.3%) presented with EV grade III were associated in 5 cases with gastric fundic varices type II. Summing, 98 ligation sessions were done on 53 patients presented with EV with high risk of bleeding. Pharmacological therapy was considered in all patients. Ligation o f EV were performed using 3 to 9 rubber bands placed in esophagocardial region, in a helical formation, starting distally and moving upward. The number of sessions ranges from 2 to 4, depending on grade and anatomic variations of EV. Serious accidents and incidents during EBV did not occur. The follow-up endoscopy 12-18 days after ligation showed complete or partial eradication of EV in 38 patients during the first session, in 9 patients after 2, in 4 after 3 and in 2 after 4 sessions. SF-36 score established that EBV has a positive influence on QL at a rate of 73% of the respondents (physical scale) and 51% (mental health scale). Conclusion: Endoscopic variceal banding is an effective method in primary prophylaxis against variceal hemorrhage and very important for improving quality of life of those patients.