Endoscopic sclerotherapy with fibrin glue as compared with polidocanol to prevent early esophageal variceal rebleeding.
OBJECTIVE
Endoscopic sclerotherapy is of proven benefit for patients after esophageal variceal bleeding, but is associated with substantial local and systemic complications. Since fibrin glue is a promising agent for endoscopic sclerotherapy of esophageal varices, we compared its safety and efficacy in patients after esophageal variceal bleeding.


METHODS
In a randomized, controlled trial, 36 patients with an acute episode of variceal bleeding were endoscopically treated with either polidocanol (18 patients) or fibrin glue (18 patients) by intravariceal injections within 12 h of admission. Tissue compatibility, incidence of various complications, episodes of rebleeding and overall survival rates were investigated.


RESULTS
Rebleeding, especially from enrollment to day 28, was less common in the fibrin group (p=0.046), and all patients treated with fibrin glue survived for more than 28 days, whereas five patients treated with polidocanol died within this period. The incidence of sclerotherapy-induced ulcers was significantly lower in the fibrin group than in the polidocanol group (p=0.001), and major complications such as perforation or ulcer bleeding were observed only in the polidocanol group. There were no complications in any group due to activation of systemic coagulation, fibrinolysis or clinically relevant pulmonary embolization.


CONCLUSIONS
We conclude that fibrin glue is an efficient and safe agent for endoscopic sclerotherapy of bleeding esophageal varices, especially in the immediate posthemorrhagic period.
Zimmer
T
T
Department of Gastroenterology, Universitätsklinikum Benjamin Franklin, Free University of Berlin, Germany.
Rucktäschel
F
F
Stölzel
U
U
Liehr
R M
RM
Schuppan
D
D
Stallmach
A
A
Zeitz
M
M
Weber
E
E
Riecken
E O
EO
D000368:Aged; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000188:drug therapy*; D016558:Hemostasis, Endoscopic; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols