What is the aim of esophageal variceal sclerotherapy--prevention of rebleeding or complete obliteration of veins?
Endoscopic variceal sclerotherapy (EVS) is highly effective in arresting active esophageal variceal bleeding. Subsequent repeated EVS sessions significantly reduce recurrence of bleeding; long-term survival is reported as prolonged or unaltered. In contrast, EVS for preventing first variceal bleeding (prophylactic sclerotherapy) is not recommended, even for high-risk patients, because it enhances mortality by significantly increasing the risk of bleeding in the treated group compared with controls. The risk of variceal rebleeding is maximum within 6 weeks of index bleeding; most patients who survive 6 weeks of variceal bleeding (with or without sclerotherapy) behave like patients who have never bled from varices. Thus, EVS continued beyond 6 weeks, to obliterate the veins completely, is akin to prophylactic sclerotherapy. Significant complications of EVS--its cost, discomfort to patient, and loss of doctor and patient time--should be weighed against doubtful benefit of continuing prolonged EVS beyond 6 weeks, just to completely obliterate esophageal veins. The possibility of better long-term survival with sclerotherapy limited to 6 weeks cannot be excluded, because prophylactic sclerotherapy shortens long-term survival.
Parikh
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Desai
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HG
D004932:Esophageal and Gastric Varices / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D012008:Recurrence; D015911:Sclerotherapy; D013997:Time Factors