title: Endoscopic ligation vs. sclerotherapy in adults with extrahepatic portal venous obstruction: a prospective randomized study.
abstract: BACKGROUND
  Endoscopic sclerotherapy is a well-established treatment for bleeding esophageal varices, although it has a substantial complication rate. A prospective randomized trial was conducted to determine whether endoscopic variceal ligation is safer and more effective than sclerotherapy in adults with bleeding esophageal varices because of extrahepatic portal venous obstruction.
  
  
  METHODS
  Thirty-six patients underwent sclerotherapy and 37 had band ligation.
  
  
  RESULTS
  Ligation and sclerotherapy were equally effective for achieving variceal eradication (94.6% vs. 91.7%, respectively; p=0.67). However, ligation achieved eradication with fewer endoscopic sessions (3.7 [1.2] vs. 7.7 [3.3]; p <0.0001) and within a shorter time interval (50.1 [17.7] days vs. 99 [54.8] days; p <0.0001). In the ligation group, recurrent bleeding was less frequent (2.7% vs. 19.4%; p=0.028; however, Bonferroni correction for multiple testing removes this significance) and the rate of major complications was lower (2.7% vs. 22.2%; p=0.014). Total cost per patient was significantly higher in the sclerotherapy vs. the ligation group ($216.6 [71.8] vs. $182.6 [63.4]; p=0.035). During the follow-up period after variceal eradication, no significant differences were found between the sclerotherapy and the ligation groups with respect to recurrent bleeding (3% vs. 2.9%; p=1.0), esophageal variceal recurrence (9.1% vs. 11.4%; p=1.0), and formation of new gastric varices (9.1% vs. 14.3%; p=0.51).
  
  
  CONCLUSIONS
  Variceal band ligation is superior to sclerotherapy, because it is less costly and achieves variceal eradication more quickly, with lower relative frequencies of recurrent variceal bleeding and complications.
authors.affiliation: Department of Gastroenterology and General Sugery, Sher-i-Kashmir Institute of Medical Sciences, Sringar, Kashmir, India.
authors.forename: Showkat Ali
authors.initials: SA
authors.lastname: Zargar
authors.forename: Gul
authors.initials: G
authors.lastname: Javid
authors.forename: Bashir Ahmad
authors.initials: BA
authors.lastname: Khan
authors.forename: Omar Javid
authors.initials: OJ
authors.lastname: Shah
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Yattoo
authors.forename: Altaf Hussain
authors.initials: AH
authors.lastname: Shah
authors.forename: Ghulam Mohammad
authors.initials: GM
authors.lastname: Gulzar
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Singh
authors.forename: Nisar Ahmad
authors.initials: NA
authors.lastname: Shah
authors.forename: Hakim Mohamad
authors.initials: HM
authors.lastname: Shafi
mesh_terms: D000293:Adolescent; D000328:Adult; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000191:economics; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008026:Ligation; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome
chemical_list: D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols