COMBINED (SHORT-TERM PLUS LONG-TERM) SCLEROTHERAPY V SHORT-TERM ONLY SCLEROTHERAPY - A RANDOMIZED PROSPECTIVE TRIAL

Short term sclerotherapy (by injection(s) around the bleeding point) i s used for immediate control of massive haemorrhage from oesophagogast ric varices. The usefulness of longterm sclerotherapy once short term sclerotherapy has been successfully carried out was assessed. Two trea tment groups were studied: 50 patients were treated by 'combined' (sho rt term followed by longterm) sclerotherapy; 56 patients were treated by short term sclerotherapy only. Patients included in the second grou p were treated by short term sclerotherapy only if a variceal rebleedi ng was present. The overall cumulative proportion of patients rebleedi ng was not significantly different in either group. Combined sclerothe rapy patients, however, experienced less episodes of variceal haemorrh age and the source of haemorrhage was different (p<0.002). Combined sc lerotherapy was more efficient in preventing bleeding from oesophageal bleeding points but not those arising from a junctional source (p<0.0 5). A greater incidence of oesophageal rebleeding was found in those p atients whose first source of bleeding was oesophageal (p<0.05). No si gnificant difference was detected in survival expectancy between eithe r group. In conclusion, after short term sclerotherapy is carried out successfully, those patients with bleeding from variceal bleeding poin ts located on oesophageal mucosa should benefit most from a longterm s clerotherapy programme.