Results of application of modified technique of esophageal varices ligation in patients with liver cirrhosis combined with hepatocellular carcinoma

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OBJECTIVE

Analysis of the results of using a modified technique of endoscopic ligation in primary and secondary prevention of bleeding from varicose veins (VV) of the esophagus in patients with liver cirrhosis combined with hepatocellular carcinoma.

MATERIAL AND METHODS

The study included 42 patients with liver cirrhosis and hepatocellular carcinoma who underwent treatment from 2019 to 2023. The technique is based on the principle of «1 ring per 1 venous trunk» to reduce the risk of bleeding and sclerotic changes in the esophagus.

RESULTS

In the study group, the incidence of complications in the form of hyperthermia in the early postoperative period was 9.5% (4 patients). No intraoperative complications were noted. No episodes of bleeding in the early and late postoperative periods were recorded. Dysphagia was observed in 7 (16.7%) patients. The severity of esophageal varices of grade I 1 month after the modified endoscopic ligation technique was observed in 29 (85.3%) patients, and grade II — in 5 (14.7%). Repeated endoscopic ligation of esophageal varices after 1 month was performed in 2 (5.9%) patients in the study group. Mortality 1 month after surgery was 19.1% (8 patients died), associated with the progression of the underlying disease.

CONCLUSION

The modified technique of endoscopic ligation of esophageal varices can be used as a palliative intervention in patients with liver cirrhosis combined with hepatocellular carcinoma for the purpose of primary and secondary prevention of bleeding, ensuring a low incidence of postoperative complications.

Keywords:

endoscopic ligation of esophageal veins

esophageal varices

primary prevention

secondary prevention

portal hypertension

Authors:

Samsonyan E.Kh.

Russian University of Medicine;
Centrosoyuz Hospital

ORCID: 0000-0001-7984-6559

Emelyanov S.I.

Russian University of Medicine

RSCI AuthorID: 526110
Scopus AuthorID: 6603872681
ORCID: 0000-0002-2575-1842

Kurganov I.A.

Russian University of Medicine

ORCID: 0000-0003-0968-3955

Received:

20.12.2024

Accepted:

09.02.2025

List of references:

Olevskaya ER. Endoscopic band ligation of esophageal varices from a to z. Klinicheskaya endoskopiya. 2024;66(1):23-28. (In Russ.). https://doi.org/10.31146/2415-7813-endo-66-1-23-28
Alvi H, Zuberi BF, Rasheed T, Ibrahim MA. Evaluation of endoscopic variceal band ligation sessions in obliteration of esophageal varices. Pakistan J Med Scie. 2020;36(2):37-41. https://doi.org/10.12669/pjms.36.2.1144
Jothimani D, Rela M, Kamath PS. Liver Cirrhosis and Portal Hypertension: How to Deal with Esophageal Varices? Med Clin North Am. 2023;107(3):491-504. https://doi.org/10.1016/j.mcna.2023.01.002
Kaprin AD. Zlokachestvennye novoobrazovaniya v Rossii v 2023 godu (zabolevaemost’ i smertnost’). Edited by AD Kaprin, VV Starinsky, AO Shahzadova. M.: MNIOI im. PA. Gercena — filial FGBU «NMIC radiologii» Minzdrava Rossii. 2024;276. (In Russ.).
Shchegolev AI, Tumanova UN, Mishnev OD. Risk factors of hepatocellular carcinoma. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. 2018;9:164-169. (In Russ.).
El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142(6):1264-1273. https://doi.org/10.1053/j.gastro.2011.12.061
Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127(5):35-50. https://doi.org/10.1053/j.gastro.2004.09.014
Shishin KV, Bakulin IG, Nedoluzhko IYu, Kurushkina NA, Babayan AF. Ligation of esophageal varicose veins as a method for the prevention of bleeding of portal genesis. Farmateka. 2016;2:31-35. (In Russ.).
Urokov ShT, Abidov UU, Hajdarov AA, Hadzhaev KSh. Experience of application of endoscopic ligation of varicose-expanded veins of esophagus in treatment of complications of portal hypertension. Novyj den’ v medicine. 2019;4(28):316-320. (In Russ.).
Katsumi T, Ueno Y. Prospects for treatment of esophageal varices considering the safety of endoscopic band ligation. Hepatol Int. 2023;7(5):1079-1081. https://doi.org/10.1007/s12072-023-10560-7
Kotel’nikova LP, Shvarev AV, Fedachuk NN, Karavaeva EA. The experience of endoscopic procedures in treatment and preventing recurrent variceal bleeding in patients with portal hypertension. Sovremennye problem nauki i obrazovaniya. 2015;3:198. (In Russ.).
Matveeva VI, Khutakov RV, Tsydenov KA, Dondupov AS, Saganov VP, Radnaev VP. Our experience of application of oesophageal varices ligation in the treatment of complications of portal hypertension in Angapov Municipal Clinical Emergency Care Hospital. Byulleten’ vostochno-sibirskogo nauchnogo tsentra sibirskogo otdeleniya rossiiskoi akademii meditsinskikh nauk. 2015;2:143-146. (In Russ.).
Shertsinger AG, Zhigalova SB, Musin RA, Dem’yanov AI, Abdullaev ICh. Complications of Endoscopic Procedures in Patients with Portal Hypertension. Annaly khirurgicheskoi gepatologii. 2007;2:16-21. (In Russ.).
Shrestha B, Kc S, Chaudhary S, Basnet BK, Mandal AK, Poudyal NS. Outcome of Endoscopic Variceal Band Ligation. J Nepal Med Assoc. 2017;56(206):198-202.
Filin AV, Myaukina LM, Filin AA. Methods to stop and to prevent bleeding in patients with varicose veins of esophagus and stomach. Eksperimental’naya I klinicheskaya gastroenterologiya. 2011;10:55-58. (In Russ.).
Mansour M, Abdel-Aziz Y, Awadh H, Shah N, Ajmera A. Complete Esophageal Obstruction after Endoscopic Variceal Band Ligation in a Patient with a Sliding Hiatal Hernia. ACG Case Rep J. 2017;18(4):8. https://doi.org/10.14309/crj.2017.8
Gabriel’ SA, Guchetl’ AYa, Durleshter VM, Dyn’ko VYu, Murashko DS, Krushel’nitskii VS. Endoscopic ligation in treatment and prevention of bleeding from esophageal varices. Pirogov Russian Journal of Surgery. 2017;2:59-63. (In Russ.). https://doi.org/10.17116/hirurgia2017259-63
Samsonyan EKh, Kurganov IA, Bogdanov DYu, Emelianov SI, Bashirov RA, Uvarova OV. Results of application of modified endoscopic varicose veins ligation with the purpose of primary prevention of bleeding. Endoscopic Surgery. 2018;24(1):15-23. (In Russ.). https://doi.org/10.17116/endoskop201824115-23
Samsonyan EKh, Kurganov IA, Bogdanov DYu, Emelianov SI, Uvarova OV. Secondary prevention of esophageal varicose veins bleeding by means of modified endoscopic ligation technique. Endoscopic Surgery. 2018;24(2):34-42. (In Russ.). https://doi.org/10.17116/endoskop201824234
Patent RF na izobretenie №RU2714393C1/14.02.2020. Byul. №5. Samsonyan EH, Emel’yanov SI, Kurganov IA, Bogdanov DYu. Sposob endoskopicheskogo ligirovaniya varikozno rasshirennyh ven pishchevoda. Ssylka aktivna na 12.12.2024. (In Russ.). https://www.fips.ru/iiss/document.xhtml?faces-redirect=true&id=907ea060712187f14a70badf760b82d3
Anisimov AIu, Vertkin AL, Deviatov AV, Dzidzava II, Zhigalova SB, Zatevakhin II, Ivashkin VT, Kitcenko EA, Kotiv BN, Lebezev VM, Lopatkina TN, Maevskaia MV, Manukian GV, Monakhov DV, Nazyrov FG, Ogurtcov PP, Pavlov ChS, Prudkov MI, Khoronko IuV, Tcitciashvili MSh, Chzhao AV, Shertcinger AG, Shipovskii VN. Klinicheskie rekomendacii po lecheniyu krovotechenij iz varikozno rasshirennyh ven pishchevoda i zheludka. Nacional’nye klinicheskie rekomendacii Rossijskogo obshchestva hirurgov. Voronezh. 2014;45. (In Russ.).
Lv YF, Han XY, Gong XG, Liu N, Yue J, Li YJ, Zhang SJ, Pang YB. Key factors of therapeutic effects for surgery in patients with cirrhotic portal hypertension. Eur Rev Med Pharmacol Sci. 2015;19(18):3492-3499.
Komilov SO. Endoskopicheskoe ligirovanie v lechenii krovotecheniya iz varikozno rasshirennyh ven pishchevoda pri cirroze pecheni. Voprosy nauki i obrazovaniya. 2022;2(158):21-27. (In Russ.).
Abdurakhmanov BA. Efficiency endoscopes technology in preventive maintenance and treatment of bleedings portal genesis at the patients with liver cirrhosis. Kreativnaia khirurgiia i onkologiia. 2010;2:38-39. (In Russ.).
Kawai T, Yashima Y, Sugimoto T, Sato T, Kanda M, Enomoto N, Sato S, Obi S. Emergency endoscopic variceal ligation following variceal rupture in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis: a retrospective study. World J Surg Oncol. 2016;24(14):52. https://doi.org/10.1186/s12957-016-0802-z
Hubutiya MSh, Pinchuk TP, Sogreshilin SS, Bugaev SA, Lucyk KN, Chugunov AO. Endoscopic hemostasis in patients with portal hypertension tumor genesis. Eksperimental’naya i klinicheskaya gastroenterologiya. 2012;6:53-57. (In Russ.).

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