ENDOSCOPIC VARICEAL LIGATION IS SUPERIOR TO COMBINED LIGATION AND SCLEROTHERAPY FOR ESOPHAGEAL-VARICES - A MULTICENTER PROSPECTIVE RANDOMIZED TRIAL

Patients who have bled from varices remain at risk for rebleeding. The re is interest in methods that would enable rapid eradication of varic es. The present trial was designed to study whether combining Ligation with sclerotherapy will allow quicker eradication of varices than eit her modality alone, Patients with bleeding esophageal varices were ran domized into ligation or combination therapy groups, Patients in the l igation group were treated with endoscopic rubber band ligation alone, Ln combination group patients, each variceal column was ligated dista lly and 1 mL of ethanolamine was injected proximal to each ligated sit e. Subsequent treatment sessions were at 7- to 14-day intervals until varices were eradicated. The clinical and endoscopic characteristics o f 25 patients in the ligation group were similar to those of 22 patien ts in the combination group. Follow-up was up to 30 months, Active ble eding was controlled in 100% of patients in the ligation group and 75% of those in combination group (P = NS). It took 3.3 +/- 4 (range, 1-7 ) sessions to eradicate varices with ligation and 4.1 +/- .6 (1-7) wit h combination therapy (P = NS). Survival (four deaths in Ligation grou p, 8 in combination group), rebleeding rate (25% vs. 36%), and varix r ecurrence (16% vs. 23%) also were similar, There were more complicatio ns with combination therapy, including deep ulcers (65% vs, 20%; P < . 05); dysphagia (30% vs. 0%; P < .05), with three strictures requiring dilation; and pain (30% vs. 10%; P = NS), Our results show that sclero therapy combined with ligation offers no benefit over Ligation alone, The higher complication rate with combination therapy does not warrant this approach.