Endoscopic Ligation of Esophageal Varices: The Experience of Aristide Le Dantec Hospital Digestive Endoscopy Center in Dakar

Introduction: Endoscopic variceal ligation (EVL) has been performed for nearly two decades in the Aristide Le Dantec Hospital digestive endoscopy center in Dakar. The aim of our study was to determine the epidemiological, diagnostical, therapeutical and evolving aspects of patients treated by ligation, and to identify factors that may influence evolution under treatment, in particular the regrowth of esophageal varices. Patients and Methods: We conducted a retrospective, descriptive and analytical study covering the period from July 2005 to December 2021. We included all patients who had undergone at least one ligation session during this period. Results: Two hundred and forty-two patients were included. The prevalence was 1.1%. The sex ratio was 1.46. The average age was 35 years. Patients presented at least one sign of portal hypertension in 57% of cases. Gastrointestinal endoscopy revealed grade III varices in 64% of cases and grade II varices in 36%. Portal hypertension was of cirrhotic origin in 68.6% of cases. Cirrhosis was of viral hepatitis B origin in 45.2% of cases. Endoscopic ligation was performed in secondary prevention in 91.7% of cases and primary prevention in 8.3%. In primary prevention, eradication was achieved in 20% of patients after an average of 2 [1-3] sessions. In secondary prevention, eradication was achieved in 36.5% of cases after an average of 4 [1-9] sessions. Tolerance was good. All patients had started propranolol after the first ligation session. Endoscopic control was performed in 63 patients (74.1%). Esophageal varices regrowth was observed in 30 patients (49.2%). In multivariate analysis, gender, variceal size, and Child-Pugh score appeared to be predictive factors for regrowth. Conclusion: In the Aristide le Dantec Hospital digestive endoscopy center, EVL is performed for primary and secondary prevention. It is well tolerated. However, esophageal variceal regrowth is frequent.