Treatment of esophageal varices: a randomized controlled trial comparing endoscopic sclerotherapy and EUS-guided sclerotherapy of esophageal collateral veins.
BACKGROUND
Endoscopic sclerotherapy (ES) and band ligation are standard treatments for esophageal varices. Unfortunately, recurrence is common and seems to be related to esophageal collateral vessels, easily identified by EUS. Eradication of these vessels might lead to a more durable therapeutic effect.


OBJECTIVE
To compare ES with EUS-guided sclerotherapy of collateral vessels (EUS-ES).


METHODS
Randomized controlled trial.


METHODS
Endoscopy Unit, Division of Gastroenterology. Universidade Federal de São Paulo, São Paulo, Brazil.


METHODS
Fifty cirrhotic patients with esophageal varices were randomized into 2 groups: ES (n = 25) and EUS-ES (n = 25). EUS-ES was targeted at collateral veins. Patients were followed-up for at least 6 months after eradication.


METHODS
Efficacy in eradication, complications, and recurrence of varices.


RESULTS
Varices were eradicated in 48 patients who adhered to the study protocol. The mean (SD) number of sessions until eradication was 4.3 (1.5) for the ES group and 4.1 (1.2) for the EUS-ES group. In ES group, 4 patients had mild bleeding. In EUS-ES group, 4 patients had pain. The mean (SD) length of the follow-up period was 22.6 (6.9) months for the ES group and 24.9 (8.1) months for the EUS-ES group. Recurrence was seen in 4 patients after ES and in 2 after EUS-ES (P = .32). The presence of collateral vessels was associated with recurrence (P = .003).


CONCLUSIONS
EUS-ES is as safe and effective as ES in variceal eradication. Recurrence tends to be less frequent and occurs later. Persistence of esophageal collateral vessels after sclerotherapy is a risk factor for recurrence.
de Paulo
Gustavo Andrade
GA
Endoscopy Unit, Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP - EPM), Brazil.
Ardengh
José Celso
JC
Nakao
Frank Shigueo
FS
Ferrari
Angelo Paulo
AP
D000328:Adult; D003097:Collateral Circulation; D018572:Disease-Free Survival; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome