RANDOMIZED TRIAL OF VARICEAL BANDING LIGATION VERSUS INJECTION SCLEROTHERAPY FOR BLEEDING ESOPHAGEAL-VARICES

Injection sclerotherapy of bleeding oesophageal varices is undoubtedly beneficial but it is associated with a substantial complication rate, and variceal rebleeding is common during the treatment period before variceal obliteration is achieved. We aimed to find out whether endosc opic variceal banding ligation is safer and more effective. The two me thods were compared in a randomised controlled trial of 103 patients ( 54 assigned to banding ligation, and 49 to injection sclerotherapy) of whom 21 (39%) and 23 (47%), respectively, had active bleeding at inde x endoscopy. Both treatments were highly effective in controlling acti ve haemorrhage (91% and 92% respectively). Variceal obliteration was n ot achieved for 22 patients in each group, but among those whose varic es were eradicated, banding ligation achieved obliteration more quickl y than did sclerotherapy (mean 39 [SD 4] vs 72 [7] days, p = 0.004) an d in fewer endoscopy sessions (3.4 [2.2] vs 4.9 [3.5], p = 0.006). Reb leeding was less common in the banding ligation group than in the scle rotherapy group (16 [30%] vs 26 [53%], p < 0.05). There was no differe nce in outcome between the groups, but 14 sclerotherapy patients were withdrawn from the trial (7 for orthotopic liver transplantation) comp ared with only 5 (1 for liver transplantation) in the banding ligation group (p < 0.05). Complication rates were similar in the two groups. Variceal banding ligation is a safe and effective technique, which obl iterates varices more quickly and with a lower rebleeding rate than in jection sclerotherapy.