title: A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding.
abstract: OBJECTIVE
  The currently recommended treatment for acute variceal bleeding is the association of vasoactive drugs and endoscopic therapy. However, which emergency endoscopic treatment combines better with drugs has not been clarified. This study compares the efficacy and safety of variceal ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin.
  
  
  METHODS
  Patients admitted with acute gastrointestinal bleeding and with suspected cirrhosis received somatostatin infusion (for 5 days). Endoscopy was performed within 6h and those with esophageal variceal bleeding were randomized to receive either sclerotherapy (N=89) or ligation (N=90).
  
  
  RESULTS
  Therapeutic failure occurred in 21 patients treated with sclerotherapy (24%) and in nine treated with ligation (10%) (RR=2.4, 95% CI=1.1-4.9). Failure to control bleeding occurred in 15% vs 4%, respectively (P=0.02). Treatment group, shock and HVPG >16 mmHg were independent predictors of failure. Side-effects occurred in 28% of patients receiving sclerotherapy vs 14% with ligation (RR=1.9, 95% CI=1.1-3.5), being serious in 13% vs 4% (P=0.04). Six-week survival probability without therapeutic failure was better with ligation (P=0.01).
  
  
  CONCLUSIONS
  The use of variceal ligation instead of sclerotherapy as emergency endoscopic therapy added to somatostatin for the treatment of acute variceal bleeding significantly improves the efficacy and safety.
authors.affiliation: Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. cvillanueva@santpau.es <cvillanueva@santpau.es>
authors.forename: Càndid
authors.initials: C
authors.lastname: Villanueva
authors.forename: Marta
authors.initials: M
authors.lastname: Piqueras
authors.forename: Carles
authors.initials: C
authors.lastname: Aracil
authors.forename: Cristina
authors.initials: C
authors.lastname: Gómez
authors.forename: Josep M
authors.initials: JM
authors.lastname: López-Balaguer
authors.forename: Begoña
authors.initials: B
authors.lastname: Gonzalez
authors.forename: Adolfo
authors.initials: A
authors.lastname: Gallego
authors.forename: Xavier
authors.initials: X
authors.lastname: Torras
authors.forename: Germà
authors.initials: G
authors.lastname: Soriano
authors.forename: Sergio
authors.initials: S
authors.lastname: Sáinz
authors.forename: Salvador
authors.initials: S
authors.lastname: Benito
authors.forename: Joaquim
authors.initials: J
authors.lastname: Balanzó
mesh_terms: D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure; D003131:Combined Modality Therapy; D004632:Emergency Medical Services; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000601:surgery*; D006728:Hormones / Q000008:administration & dosage*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008026:Ligation; D008297:Male; D008875:Middle Aged; D015911:Sclerotherapy; D013004:Somatostatin / Q000008:administration & dosage*; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D006728:Hormones; D013004:Somatostatin