A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding.
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.
Villanueva
Càndid
C
Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. cvillanueva@santpau.es <cvillanueva@santpau.es>
Piqueras
Marta
M
Aracil
Carles
C
Gómez
Cristina
C
López-Balaguer
Josep M
JM
Gonzalez
Begoña
B
Gallego
Adolfo
A
Torras
Xavier
X
Soriano
Germà
G
Sáinz
Sergio
S
Benito
Salvador
S
Balanzó
Joaquim
J
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
D006728:Hormones; D013004:Somatostatin