IDDF2024-ABS-0092 Safety and efficacy of endoscopic variceal ligation as a primary prophylaxis in esophageal varices. A prospective observational study from a high volume centre in India

Background Endoscopic variceal ligation (EVL) is an effective treatment modality for esophageal varices. Its usefulness is evident in secondary prophylaxis. However, the literature about its role in primary prophylaxis is scanty. To find the same, we conducted this study. Methods Chronic liver disease with portal hypertension patients with or without variceal bleeding were recruited for the study. Primary EVL was done in patients with large esophageal varices or small varices with red colour signs and having contraindications to beta-blockers. Secondary EVL was done to all with bleeding varices or having stigmata of recent haemorrhage (SRH) besides putting them on beta-blockers. Patients were followed for a long time. They were assessed for the recurrence of varices, rebleeding, and mortality. EVL was done as primary prophylaxis in 120 and as secondary prophylaxis in 235 patients. Results 355 CLD/PHTN patients (mean age 46.53 ± 8.16 years, 253 Males) underwent 400 endoscopic variceal ligation (EVL) sessions. The etiology was alcohol in 43.5%, viral hepatitis in 30.5%, and non-alcoholic steatohepatitis (NASH) in 23.8%. 243 (68.45%) of patients had large esophageal varices. Variceal eradication was accomplished in 100% of patients. However, 13.3% of patients had a recurrence in the meantime of 43.64 ± 12.8 months. There was no immediate post-EVL bleeding or 30-day mortality in primary prophylaxis. However, Immediate rebleeding occurred in 19 (8.08%) of patients in secondary prophylaxis .6/19 (31.57%) of patients died within 30 days. Overall, rebleeding occurred in 13.5% of patients over the study period. There was no statistically significant difference in variceal recurrence (12.6% versus 16.3%) and rate of rebleeding (6.7% versus 9.8%) between primary and secondary EVL. Rebleeding rates following 1, 3 and 5 years were 2.6%, 4.2%, and 6.7%, separately. The overall mortality among the studied patients was 69.3% due to the progression of CLD. Only 6.8% of patients died because of rebleeding. On subgroup examination, the elements essentially connected with rebleeding were large varices, Child-Pugh class C, low albumin, and severe Portal Hypertensive Gastropathy (PHG). Conclusions Endoscopic variceal ligation (EVL) is a safe and effective long-term treatment modality for both primary and secondary prophylaxis of oesophageal varices.