A comparison of combination endoscopic therapy and interventional radiology with esophageal transection for the treatment of esophageal varices.

BACKGROUND/AIMS: The impact of long-term results of combination interventional radiology and endoscopic therapy were compared with esophageal transsection for the treatment of esophageal varices.

METHODOLOGY: This study was a retrospective chart review. The outcome of 16 patients with esophageal varices who underwent endoscopic therapy plus all interventional radiologic procedures (transportal vein obliteration, partial splenic embolization, and left gastric arterial embolization) were compared with those of 23 who underwent esophageal transection. Primary endpoints during a 5-year follow-up included retreatment and death.

RESULTS

The retreatment rates at 1 year, 3 years, and 5 years in the combined therapy group and transection group were 16.7% and 8.7%, 58.3% and 25.2% and 75.0% and 31.2%, respectively. The retreatment rates were lower in the transection group than in the combined therapy group (p = 0.015). Cumulative retreatment rates in Child's class C patients were significantly different between the two groups. The survival rates at 3 years and 5 years in the combined therapy group and transection group were similar 91.7% versus 91.7% and 82.5% versus 89.5%. The cumulative retreatment rates also were similar.

CONCLUSIONS

The combination of interventional radiologic and endoscopic therapy is highly effective and provides an alternative to surgery in patients with esophageal varices who have poor liver function.