Complications of endoscopic ligation of varicose veins in patients with portal hypertension

Abstract

Objective: The aim of the investigation is to analyze the results of endoscopic varicose vein ligation (EVL) in patients with portal hypertension; to estimate the character and frequency of early and late postoperative complications after EVL; to evaluate the possibility of endoscopic ligation at the moment of active bleeding. Methods: This work includes an analysis of 138 procedures for endoscopic ligation of the esophageal varices in 111 patients from 2016 to 2020. Intrahepatic form of portal hypertension was in 90 patients, extrahepatic form - in 21 patients. The total number of interventions performed was divided into 2 groups. In the first group of patients with EVL was performed urgently, and the second group includes patients, if necessary, with targeted prescription and secondary prevention of portal esophageal bleeding. Results: In 74 (53.6%) cases out of 138, different types of complications were detected. There were 2 lethal cases (1.4%). It should be noted that there were no lethal outcomes in second group after EVL, and after urgent operations, the mortality rate was 33.3%. The most critical complication of ligation was the resumption of hemorrhage due to the site of ligation in the early (1-3 days) and late periods after surgery (5-10 days). Conclusion: In this analysis of the studied cases of complications after EVL, the most common complication was pain syndrome and early and late bleeding were also identified. We showed that control esophagogastroscopies helped to identify bleeding recurrences; examination algorithms in case of detection of bleeding complication after EVL, and measures to prevent the development of recurrent hemorrhage were also necessary.

Keywords

• esophagus
• esophageal varices
• endoscopic ligation
• endoscopic ligator