title: Randomized controlled trial of scleroligation versus band ligation alone for eradication of gastroesophageal varices.
abstract: OBJECTIVE
  Gastric varices develop in 5% to 33% of patients with portal hypertension. Their most common form is concomitant gastroesophageal varices. Scleroligation (combined sclerotherapy and band ligation) has been used successfully in management of esophageal varices but has not been evaluated previously in the management of gastroesophageal varices. The aim of this work was evaluation of a new scleroligation technique for management of bleeding gastroesophageal varices regarding efficacy, adverse events, variceal recurrence, and survival.
  
  
  METHODS
  This study was conducted on 120 cirrhotic patients with bleeding gastroesophageal varices, whom we divided randomly into 2 groups of 60 patients each-a band ligation group and a scleroligation group.
  
  
  RESULTS
  The mean number of sessions was lower in the scleroligation group than in the band ligation group (2.22 ± 0.92 and 3.43 ± 0.67, respectively) (P < .001), as were the duration of treatment and total number of bands used. Cost and survival were comparable in the 2 groups. There was no significant difference between the 2 maneuvers regarding adverse events, recurrence rates, or rebleeding rates after obliteration. Recurrence was significantly higher in patients with larger varices, ulceration, and postprocedure pyrexia. Rebleeding was significantly higher among those who experienced postprocedure pyrexia and developed or had worsening of gastric antral vascular ectasia.
  
  
  CONCLUSIONS
  Scleroligation appears to achieve a faster rate of eradication with fewer treatment sessions and total number of bands deployed to achieve variceal obliteration than band ligation and is comparable in cost and in adverse event and recurrence rates. (Clinical trial registration number: NCT02646202.).
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
authors.forename: Loai
authors.initials: L
authors.lastname: Mansour
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
authors.forename: Ferial
authors.initials: F
authors.lastname: El-Kalla
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
authors.forename: Hanan
authors.initials: H
authors.lastname: El-Bassat
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
authors.forename: Sherief
authors.initials: S
authors.lastname: Abd-Elsalam
authors.affiliation: Internal Medicine Department, Tanta University, Tanta, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Bedewy
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
authors.forename: Abdelrahman
authors.initials: A
authors.lastname: Kobtan
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
authors.forename: Rehab
authors.initials: R
authors.lastname: Badawi
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elhendawy
mesh_terms: D003131:Combined Modality Therapy / Q000009:adverse effects / Q000191:economics; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology; D020252:Gastric Antral Vascular Ectasia / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000191:economics; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D015911:Sclerotherapy / Q000009:adverse effects / Q000191:economics; D015996:Survival Rate