Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices.
BACKGROUND
Endoscopic sclerotherapy is an absolute indication for treating esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated.


OBJECTIVE
To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation.


METHODS
Forty-six patients with liver cirrhosis and esophageal varices were prospectively randomized into two treatment groups: endoscopic sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. Informed writing consent was obtained from every patient and the Ethics Committee of Federal University of São Paulo, SP, Brazil, approved the study. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence.


RESULTS
Both groups were similar except that male gender was more common in the sclerotherapy group. There was no statistical difference regarding variceal eradication (78.3% in sclerotherapy group vs 73.9% in the ligation group), recurrence (26.7% vs 42.9%, respectively) and death related to any cause (21.7% vs 13.9%). In the sclerotherapy group more sessions were need to obtain complete variceal eradication. In this group we did observe a high re-bleeding rate (34.8%) and more ulcers associated with retrosternal pain right after the procedure. There was no difference regarding overall morbidity and mortality.


CONCLUSIONS
Banding ligation requires fewer sessions than sclerotherapy with absolute alcohol to eradicate esophageal varices. Both methods are equally efficient regarding variceal eradication and recurrence during a short follow-up period.
Ferrari
Angelo Paulo
AP
Division of Gastroenterology, Federal University of São Paulo, São Paulo, SP, Brazil. angelo@gatro.epm.br
de Paulo
Gustavo Andrade
GA
de Macedo
Claudia Maria Ferreira
CM
Araújo
Isabela
I
Della Libera
Ermelindo
E
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
D000431:Ethanol