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Adjuvant sclerotherapy after ligation for the treatment of esophageal varices: a prospective, randomized long-term study.

Abstract：

BACKGROUND:To assess the efficacy of adjuvant sclerotherapy after banding for the treatment of esophageal varices, a randomized trial was carried out of endoscopic variceal ligation (EVL) alone with sequential sclerotherapy versus sequential ligation-sclerotherapy (SLS) after banding with respect to variceal eradication, associated complications, and recurrence of varices. METHODS:One hundred patients qualified for this study. Fourteen patients were not included for the following reasons: 6 chose not to participate, 4 had fundal varices, and 4 had some form of cancer. Of the remaining 86 patients in the study, 42 underwent EVL alone and the other 44 SLS. Variceal ligation was begun in the region of the gastroesophageal junction, with subsequent ligatures applied cephalad 3 to 5 cm; ligation was repeated every 2 weeks until variceal obliteration. For SLS, ligation was also begun in the region of the gastroesophageal junction and repeated until varices were reduced to F1 size. Subsequently, these patients underwent sclerotherapy with between 6 and 8 mL of sodium tetradecyl sulfate (free hand technique). RESULTS:No significant differences were found between EVL alone and SLS with regard to variceal eradication, development of associated complications, and recurrent bleeding during a follow-up of 2 years. The probability of variceal recurrence requiring further treatment after 1 year was 14% for the SLS group and 26% for EVL group patients. Another year later, the probability of variceal recurrence was 24% and 45%, respectively, for the SLS and EVL groups. CONCLUSIONS:Because a significantly lower rate of variceal recurrence was found for SLS patients, sequential sclerotherapy followed by ligation to eradicate those varices too small to easily band may be a better procedure.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Cheng YS,Pan S,Lien GS,Suk FM,Wu MS,Chen JN,Chen SH

doi

10.1067/mge.2001.114061

keywords:

subject

Has Abstract

pub_date

2001-05-01 00:00:00

pages

566-71

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(01)70253-2

journal_volume

pub_type

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Adjuvant sclerotherapy after ligation for the treatment of esophageal varices: a prospective, randomized long-term study.