The additive effect of sclerotherapy to patients receiving repeated endoscopic variceal ligation: A prospective, randomized trial

Endoscopic variceal ligation (EVL) is a new technique designed to manage esophageal varices. The effect of sclerotherapy following repeated banding ligation remains unknown. Seventy‐two patients with a history of esophageal variceal bleeding received regular EVL until variceal disappearance or until left with residual small varices. Subsequently, patients were randomized to receive sclerotherapy (Group 1, 37 patients) or serve as a control (Group 2, 35 patients). Group 1 received one to two sessions of low‐dose sclerotherapy to achieve complete variceal disappearance. After a mean follow‐up of 2 years, 4 months, recurrent esophageal varices developed in 14% of Group 1 and 43% of Group 2 (P < .02). Rebleeding was encountered in 8% of Group 1 versus 31% of Group 2 (P= .01). One case of esophageal stricture (2.7%) was encountered in Group 1. One patient in Group 1, compared with 3 patients in Group 2, died of massive variceal bleeding (P> .05). The multivariate Cox model indicated that treatment was the only factor predictive of variceal recurrence, and both Child‐Pugh class and treatment were factors predictive of variceal rebleeding. The addition of low‐dose sclerotherapy following repeated banding ligations proved safe and effective in the prevention of recurrence of esophageal varices and rebleeding.

[1]  I. Waked,et al.  Analysis of long-term endoscopic surveillance during follow-up after variceal sclerotherapy from a 13-year experience. , 1997, The American journal of medicine.

[2]  G. Stiegmann,et al.  Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices: A multicenter prospective randomized trial , 1997, Hepatology.

[3]  L. Laine,et al.  Randomized comparison of ligation versus ligation plus sclerotherapy in patients with bleeding esophageal varices. , 1996, Gastroenterology.

[4]  Loren Laine.  Ligation: Endoscopic treatment of choice for patients with bleeding esophageal varices? , 1995, Hepatology.

[5]  K. Lai,et al.  A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices , 1995, Hepatology.

[6]  Shou-Dong Lee,et al.  Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: A prospective randomized trial , 1995, Hepatology.

[7]  K. Lai,et al.  A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices. , 1994, Gastrointestinal endoscopy.

[8]  R. Schapiro.  … and the bands play on Gimson AES, Ramage JK, Panos MZ, Hayllar K, Harrison PM, Williams R, Westaby D. Randomized trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices. Lancet 1993; 342: 391–394 , 1994 .

[9]  A. Gimson,et al.  Randomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices , 1993, The Lancet.

[10]  S. D. Lee,et al.  Does propranolol maintain post‐sclerotherapy variceal obliteration? A prospective randomized study , 1993, Journal of gastroenterology and hepatology.

[11]  H. El-Newihi,et al.  Endoscopic Ligation Compared with Sclerotherapy for the Treatment of Bleeding Esophageal Varices , 1993, Annals of Internal Medicine.

[12]  S. Lowenstein,et al.  Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. , 1992, The New England journal of medicine.

[13]  S. D. Lee,et al.  Injection sclerotherapy preceded by esophageal tamponade versus immediate sclerotherapy in arresting active variceal bleeding: a prospective randomized trial. , 1992, Gastrointestinal endoscopy.

[14]  J. Villeneuve,et al.  Role of endoscopic variceal sclerotherapy in the long-term management of variceal bleeding: a meta-analysis. , 1989, Gastroenterology.

[15]  J. Pitcher.  Variceal sclerotherapy: The combination of thrombosclerosis and the intentional removal of the distal esophageal mucosa to treat variceal bleeding and to prevent variceal recurrence , 1987 .

[16]  J. W. Griffin,et al.  Complications of endoscopic injection sclerotherapy: a review. , 1987, The American journal of gastroenterology.

[17]  S. Kitano,et al.  Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate , 1987, Hepatology.

[18]  G. Stiegmann,et al.  A new endoscopic elastic band ligating device. , 1986, Gastrointestinal endoscopy.

[19]  N. Soehendra,et al.  Endoscopic Obliteration of Large Esophagogastric Varices with Bucrylate , 1986, Endoscopy.

[20]  Roger M. Williams,et al.  Improved survival following injection sclerotherapy for esophageal varices: Final analysis of a controlled trial , 1985, Hepatology.

[21]  L. Balart,et al.  A prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy , 1985, Hepatology.

[22]  S. Kitano,et al.  Prediction of variceal hemorrhage by esophageal endoscopy. , 1981, Gastrointestinal endoscopy.

[23]  R. Pugh,et al.  Transection of the oesophagus for bleeding oesophageal varices , 1973, The British journal of surgery.

[24]  M. Hashizume,et al.  Endoscopic ligation of esophageal varices compared with injection sclerotherapy: a prospective randomized trial. , 1993, Gastrointestinal endoscopy.

[25]  J. Fermanian,et al.  Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociations, and relationship to hepatic dysfunction. , 1990, Gastroenterology.