Liver cell failure is one of the most dangerous diseases in Egypt Portal hypertension is the most devastating complication of chronic liver diseases and is the most common cause of mortality and morbidity in patients with liver cirrhosis. Haematemesis is the most important complication of portal hypertension threatening the patient’s life. Esophageal varices are considered the first cause of haematemesis in patients with portal hypertension in Egypt. Endoscopic variceal ligation (EVL) is increasingly becoming the most suitable method for eradication of esophageal varices aiming to decrease the incidence of recurrent variceal bleeding. In spite of this, it has minimal post banding complications compared to other methods. One of these complications is post banding ulcer formation and hence post banding bleeding.
This study was designed to evaluate the effect of proton pump inhibitors (PPI) on post banding complications and ulcer formation. It included 60 patients presented for secondary prophylaxis for bleeding esophageal varices in the Endoscopy unit of Ain Shams University Hospital .All patients underwent esophageal variceal band ligation as a secondary prophylactic method.(Eight cases 8) were excluded from the study due to lost follow up so the valid number of patients who completed the study were 52 patients.
¬They were randomly classified into two groups; (group I) composed of 26 patients (after exclusion of 4 patients) and was treated with placebo while the other group (group II) composed of 26 patients (after exclusion of 4 patients) and was treated with PPI. Both groups were subjected to thorough history taking, clinical examination, laboratory investigations, abdominal ultrasonography and upper GI endoscopy and were followed up after one week for symptoms followed EVL and two weeks for upper endoscope and the same symptoms (chest pain, dysphagia and rebleeding).
It was found that in the group who receive PPI and the group who receive the placebo drug there were no cases with post banding bleeding or deaths.
Regarding Post banding ulcer formation it was distributed between the two studied groups as follow 11 patients(42.31%) in group I(placebo) and 13 patients (50%) in group II(PPI) didn’t develop post banding esophageal ulcers ,and 3 patients(11.54%) in group I (placebo) and 4 patients(15.38%) in groupII (PPI) developed single post banding ulcer ,also 11 patients (42.31%) in group I(placebo) and 9 patients(34.62%) in group II(PPI) developed two post banding esophageal ulcers ,while only one patient (3.85) in group I (placebo) had three post banding esophageal ulcers. With no statistically significant difference between the two groups.
The mean size of these ulcers was about4.2±1.7mm in group group II (PPI) while it was 6.5±3.65 mm. in group I (placebo) which is statistically significant.
There was no post banding bleeding between the studied groups of patients.
Regarding post banding chest pain there were no statistically significant difference between the two studied groups.
While post banding dysphagia was lesser in the drug group with statistically significant difference.
Finally, this study concludes that EVL is a safe technique for prophylactic variceal band ligation. Post banding ulcer formation is of low incidence and risk. PPI administration after band ligation has no significant effect on post banding ulcer formation but have significant effect on reducing the ulcer size. And post banding dysphagia. |
