SEQUELAE AFTER ESOPHAGEAL VARICEAL LIGATION AND SCLEROTHERAPY - A PROSPECTIVE RANDOMIZED STUDY

Objectives: Esophageal variceal ligation is a new approach to the trea tment of esophageal varices that does not result in transmural tissue injury and inflammation, and therefore might produce fewer sequelae an d symptoms than sclerotherapy. We conducted a prospective, randomized comparison of sclerotherapy with ligation to study the relative short- term risks of these two procedures with respect to bacteremia, pulmona ry and coagulation function, esophageal motility, and gastroesophageal reflux. Methods: Patients with previously documented high grade esoph ageal varices were randomized to receive sclerotherapy or ligation. Bl ood was drawn for culture and coagulation profiles, and patients under went pulmonary function tests, esophageal manometry, and intraesophage al pH monitoring before and after treatment. Results: Six patients wit h Childs class B cirrhosis and one patient with presinusoidal portal h ypertension underwent 20 courses of therapy. Neither sclerotherapy nor ligation produced significant clinical changes in pulmonary or coagul ation parameters, or bacteremia requiring treatment. The majority of l igation treatments were without worsening of motility or reflux scores , and none were associated with symptoms. Sclerotherapy was followed b y significantly greater esophageal dysmotility and worsening reflux pa tterns. Conclusions: Patient acceptance of ligation was much greater t han that for sclerotherapy. Our data define the advantages of ligation over sclerotherapy.