Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices: a prospective randomized study.
BACKGROUND
We devised a new combined method of endoscopic variceal ligation and injection sclerotherapy, namely, endoscopic scleroligation, for the treatment of esophageal varices. The aim of this prospective randomized trial was to compare endoscopic scleroligation with endoscopic variceal ligation alone with regard to efficacy, complications, variceal recurrence, and survival.


METHODS
Fifty-one patients with cirrhosis and esophageal varices were randomly assigned to be treated by endoscopic scleroligation (n = 25) or endoscopic variceal ligation (n = 26). In the initial session in the endoscopic scleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterate the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endoscopic injection sclerotherapy was performed with 1% polidocanol. In the endoscopic variceal ligation group, that procedure was performed in all treatment sessions.


RESULTS
Both methods were equally effective in achieving complete eradication of esophageal varices. Among the cases in which complete eradication was achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) (p < 0.01). The survival rates and incidences of treatment-related complications have been similar among patients treated by both methods.


CONCLUSIONS
Endoscopic scleroligation is superior to endoscopic variceal ligation in preventing variceal recurrence.
Umehara
M
M
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Onda
M
M
Tajiri
T
T
Toba
M
M
Yoshida
H
H
Yamashita
K
K
D000368:Aged; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007479:Iopamidol / Q000008:administration & dosage; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
D009829:Oleic Acids; D012597:Sclerosing Solutions; D007479:Iopamidol; C033343:ethanolamine oleate