The standard versus locally improvised banding for bleeding oesophageal varices: case control study

Abstract

INTRODUCTION: Endoscopic band ligation is one of the effective therapeutic modalities in variceal bleeding. However the availability of endoscopic banding is mainly overshadowed by its overwhelming cost; especially in a country like Sri Lanka. This study assesses the therapeutic outcome of standard verses locally improvised endoscopic banding in oesophageal varices. METHODS: A study was carried out among 446 (90- standard band ligation, 356-locaIly improvised) patients with acute oesophageal variceal bleeding who were referred to gastroenterology unit of National Hospital of Sri Lanka between January 2005 to December 2008. Consecutive patients with oesophageal variceal bleeding were recruited either uTreceive standard or locally improvised bands, based on the availability of standard banding sets in the unit. The early re-bleeding and hospital mortality rates were compared. RESULTS: Ninety patients (M: F^ 68: 22, mean age: 49.3 years, range- 35 years to 68 years) were treated with standard (Six shooter or Super?) variceal bands, whilst, 356 (Male: 272, Female: 84, mean age: 48.3 years, range- 34 years to 71 years) had locally improvised bands. Early re-bleeding rate with locally improvised band therapy was 8.4% whereas with standard banding, it was 3.3% (p=0.02). In-hospital mortality (of any cause) rates for standard and locally improvised bands were 6/90 (6.6%) and 26/356 (7.3%) respectively (p=0.02). The cost for each standard banding set is LKR 20000±2000 and locally improvised bands approximately LKR 5±0.57 (p=0.001) CONCLUSION: There are differences in re-bleeding and in-hospital mortality with the use of locally improvised band therapy. However the cost of locally improvised band therapy is low.