ENDOSCOPIC INJECTION SCLEROTHERAPY VS ENDOSCOPIC VARICEAL LIGATION INARRESTING ACUTE VARICEAL BLEEDING FOR PATIENTS WITH ADVANCED HEPATOCELLULAR-CARCINOMA

Patients with advanced hepatocellular carcinoma and acute esophageal v ariceal bleeding have a very poor prognosis. To compare the efficacy a nd complications of sclerotherapy and banding ligation, patients with acute esophageal variceal bleeding and concomitant hepatocellular carc inoma were randomly allocated to receive either sclerotherapy (endosco pic injection sclerotherapy group, 27 patients) or banding ligation (e ndoscopic variceal ligation group, 30 patients). All patients received treatment within 24 h of index bleeding. Initial control of bleeding was achieved in 41% of the endoscopic injection sclerotherapy group an d 87% of the endoscopic variceal ligation group (p<0.001). The re-blee ding rates were 73% and 42%, respectively (p<0.05). The amount of bloo d transfused during the week after treatment was significantly higher in the endoscopic injection sclerotherapy than in the endoscopic varic eal ligation group (3.9+/-1.5 vs. 1.5+/-0.8 units, respectively) (p<0. 01). Major complications were more often encountered in the endoscopic injection sclerotherapy group (22%) than in the endoscopic variceal l igation group (3%) (p<0.05). Twenty-three patients in the endoscopic i njection sclerotherapy group and 25 patients in the endoscopic varicea l ligation group have so far died. The mean survival was 25+/-16 days in the endoscopic injection sclerotherapy group and 49+/-14 days in th e endoscopic variceal ligation group (p<0.05). Variceal bleeding was t he main cause of mortality in the endoscopic injection sclerotherapy g roup (70%), whereas in the endoscopic variceal ligation group, hepatic failure (48%), rather than variceal bleeding (28%), was the major cau se. We conclude that endoscopic banding ligation is superior to inject ion sclerotherapy in the management of acute esophageal variceal bleed ing associated with advanced hepatocellular carcinoma. (C) Journal of Hepatology.