Endoscopic ligation vs. sclerotherapy in adults with extrahepatic portal venous obstruction: a prospective randomized study.
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.
Zargar
Showkat Ali
SA
Department of Gastroenterology and General Sugery, Sher-i-Kashmir Institute of Medical Sciences, Sringar, Kashmir, India.
Javid
Gul
G
Khan
Bashir Ahmad
BA
Shah
Omar Javid
OJ
Yattoo
Ghulam Nabi
GN
Shah
Altaf Hussain
AH
Gulzar
Ghulam Mohammad
GM
Singh
Jaswinder
J
Shah
Nisar Ahmad
NA
Shafi
Hakim Mohamad
HM
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
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols