Efficacy of endoscopic variceal ligation for bleeding esophageal varices in patients with tumor thrombus of the portal vein trunk (Vp3) associated with hepatocellular carcinoma.

We studied the efficacy of endoscopic variceal ligation (EVL) in 16 patients with tumor thrombus of the portal vein trunk (Vp3) associated with hepatocellular carcinoma. The average (+/-SD) number of O rings used was 9.0 +/- 5.0 for the esophageal varices (n = 7) and 16.4 +/- 4.5 for the esophagogastric varices (n = 9). The variceal size was quickly reduced in 11 of the 13 cases whose therapeutic outcome was able to be assessed by endoscopy. The red color sign improved in 10 of the 13 cases, but the therapeutic end point (F0, RC-) was achieved in only two patients, who were also treated by endoscopic injection sclerotherapy. Emergency EVL achieved only short-term survival (17.14 +/- 6.64 days) and transient hemostasis. Elective EVL was associated with a survival duration of 90.0 +/- 64.25 days. The difference in the survival rate between emergency and elective cases was significant (P < .05). With regard to the timing of its application, EVL, being a less-invasive treatment, should be performed electively before variceal rebleeding for those patients with Vp3 hepatocellular carcinoma whose liver function is preserved.