Randomized comparison of ligation versus ligation plus sclerotherapy in patients with bleeding esophageal varices.
OBJECTIVE
Combining endoscopic sclerotherapy with ligation has been proposed to hasten variceal eradication. A randomized trial was performed comparing combination ligation plus sclerotherapy with ligation alone in patients with major bleeding from esophageal varices.


METHODS
Forty-one patients were randomly assigned to receive ligation or ligation plus 1 mL 1.5% tetradecyl injected just above each band. Treatment was repeated weekly until varices were eradicated. Repeat endoscopy was performed for rebleeding and every 3 months after eradication.


RESULTS
No significant differences were found between combined therapy and ligation in rebleeding (29% vs. 30%), blood transfused (3.1 +/- 1.1 vs. 2.0 +/- 0.8 U), hospital days (9.3 +/- 2.1 vs. 7.5 +/- 1.2), complications (29% vs. 10%), or deaths (14% vs. 15%) during a mean follow-up period of 28 weeks. Combined therapy required significantly more sessions to achieve eradication (4.9 +/- 0.6 vs. 2.7 +/- 0.4) and greater time per treatment session (18.3 +/- 1.7 vs. 13.3 +/- 0.5 minutes).


CONCLUSIONS
Combined ligation plus sclerotherapy does not reduce the number of treatment sessions required for variceal eradication as compared with ligation alone. Combined therapy lengthens the time required for treatment without improving efficacy or decreasing complications. Thus, combined ligation and sclerotherapy should not be used to treat patients with bleeding esophageal varices.
Laine
L
L
Division of Gastrointestinal and Liver Diseases, University of Southern California School of Medicine, Los Angeles, USA.
Stein
C
C
Sharma
V
V
D000328:Adult; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy; D013997:Time Factors