Premium
Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: A prospective randomized trial
Author(s) -
Hou MingChih,
Lin HanChieh,
Kuo Benjamin IngTiau,
Chen ChenHsiang,
Lee FaYauh,
Lee ShouDong
Publication year - 1995
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840210607
Subject(s) - sclerotherapy , medicine , ligation , esophageal varices , varices , surgery , varix , randomized controlled trial , complication , gastroenterology , portal hypertension , cirrhosis
To determine the efficacy of endoscopic variceal sclerotherapy (EVS) and ligation (EVL) in the management of esophageal variceal bleeding, 134 cirrhotic patients were randomized to receive either treatment. The clinical and endoscopic characteristics were similar in both groups. Active bleeding was controlled with ligation (20 of 20) as efficiently as with sclerotherapy (14 of 16). Elective sclerotherapy consumed less time than ligation (7.9 ± 1.8 minutes vs 11.5 ± 2.7 minutes, P < 0.001), but there was no difference between emergent sclerotherapy (14.5 ± 5.8 minutes) and ligation (14.9 ± 4.1 minutes). Ligation reduced one grade of variceal size more quickly than sclerotherapy (1.1 ± 0.4 vs 2.0 ± 1.7 session, P < 0.001). The rebleeding rate was lower with h'gation (13 of 67 vs. 28 of 67, P < 0.01). Esophageal ulcer was the most common source of rebleeding. Recurrence of varices appears more probable with ligation ( P = 0.079). The complication rate was higher with sclerotherapy (15 of 67 vs. 3 of 67, P < 0.01), with esophageal stricture being the most common cause. Survival rate was the same in both groups even after stratifying patients into good and poor hepatic reserve groups. Hepatic failure was the major cause of death, followed by exsanguination. In summary, EVL was superior to EVS regarding rebleeding and complications but not in other aspects such as tune consumption in elective treatment and recurrence of varices. Substantial results for long‐term follow‐up are required before conclusion of the treatment of choice.