To ligate or sclerose: beginning of a new era in the management of esophageal varices?

Sarin, S. K. ; Bhatia, Professor V. (1993) To ligate or sclerose: beginning of a new era in the management of esophageal varices? Hepatology, 17 (4). pp. 746-748. ISSN 0270-9139

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Official URL: http://onlinelibrary.wiley.com/doi/10.1002/hep.184...

Related URL: http://dx.doi.org/10.1002/hep.1840170431

Abstract

Background: Endoscopic sclerotherapy is an accepted treatment for bleeding esophageal varices, but it is associated with substantial local and systemic complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, may be safer. We compared the effectiveness and safety of the two techniques. Methods: In this randomized trial we compared endoscopic sclerotherapy and endoscopic ligation in 129 patients with cirrhosis who had proved bleeding from esophageal varices. Sixty-five patients were treated with sclerotherapy, and 64 with ligation. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications and recurrences of bleeding, the number of treatments needed to eradicate varices, and survival. Results: Active bleeding at the first treatment was controlled by sclerotherapy in 10 of 13 patients (77 percent) and by ligation in 12 of 14 patients (86 percent). Slightly more sclerotherapy-treated patients had recurrent hemorrhage during the study (48 percent vs. 36 percent for the ligation-treated patients, P = 0.072). The eradication of varices required a lower mean (± SD) number of treatments with ligation (4 ± 2 vs. 5 ± 2, P = 0.056) than with sclerotherapy. The mortality rate was significantly higher in the sclerotherapy group (45 percent vs. 28 percent, P = 0.041), as was the rate of complications (22 percent vs. 2 percent, P < 0.001). The complications of sclerotherapy were predominantly esophageal strictures, pneumonias, and other infections. Conclusions: Patients with cirrhosis who have bleeding esophageal varices have fewer treatment-related complications and better survival rates when they are treated by esophageal ligation than when they are treated by sclerotherapy.

Item Type:Article
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Deposited On:21 Jun 2011 06:52
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