الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Introduction: Gastrointestinal bleeding is the most severe complication of portal hypertension, and esophageal and gastric varices are by far the most common sources of bleeding in these patients. Endoscopic injection sclerotherapy is widely used for treatment of bleeding esophageal varices. However, the high incidence of variceal recurrence and rebleeding may be as high as 50% still represents a major clinical problem. Aim of the work: The aim of the present clinical trial is to assess safety and efficacy of endoscopic sclerotherapy (EST) plus Argon plasma coagulation (APC) versus endoscopic sclerotherapy alone for the prevention of variceal recurrence and rebleeding. Patients and Methods: All patients were subjected to thorough history taking, full clinical examination, complete laboratory and haematological investigations. After control of the initial bleeding episode, patients were randomly divided into 2 groups: Group I: Included 50 patients, 40 males and 10 females. They were treated by injection sclerotherapy, at 2 weeks intervals until complete variceal eradication. Then 3 sessions of APC of the lower esophageal mucosa were done at 24 weeks intervals. After each APC session, patients were given omeprazole (20 mg/d) PO for one month to promote healing of the coagulated tissue. Group II: Included 50 patients, 38 males and 12 females. They were treated by regular injection sclerotherapy alone, at 2 weeks intervals until complete variceal eradication. Results: Variceal recurrence occurred in 7 patients (14%) of group I and in 19 patients (38%) of group II (P = 0.006). Variceal rebleeding occurred one patient (2%) in group I and 7 patients (14%) in group II (P = 0.027).A significantly higher incidence of fever was recorded in the combined group (P = 0.03). Conclusion: Combination of injection sclerotherapy and argon plasma coagulation as a mucosal fibrosis therapy is superior to sclerotherapy alone in decreasing the incidence of variceal recurrence and rebleeding.