ENDOSCOPIC LIGATION OF ESOPHAGEAL-VARICES COMPARED WITH INJECTION SCLEROTHERAPY - A PROSPECTIVE RANDOMIZED TRIAL

Fifty cirrhotic patients with esophageal varices underwent endoscopic treatment in a prospective randomized trial carried out to compare var iceal ligation with injection sclerotherapy, with respect to safety, e fficacy, and complications in the initial session. Twenty-five patient s each were treated using endoscopic variceal ligation or endoscopic i njection sclerotherapy in the initial session and then only endoscopic injection sclerotherapy for all following sessions. Ligations numbere d 4.1 at the initial session. The total number of sessions of endoscop ic injection sclerotherapy was 4.0 +/- 1.3 in the endoscopic injection sclerotherapy group compared with 3.6 +/- 1.4 in the endoscopic varic eal ligation group. The total volume of the sclerosant used by the end of all the sessions was 23.9 +/- 10.3 ml in the endoscopic variceal l igation group and 39.0 +/- 11.5 ml in the endoscopic injection sclerot herapy group (p < 0.0001). In all patients, complete eradication of th e varices was achieved, and at 7 to 15 months follow-up no evidence of recurrence was seen. Adverse effects such as pyrexia, chest pain, and pleural effusion after the initial session were significantly lower i n the endoscopic variceal ligation group (p < 0.05), and total bilirub in, serum creatinine, lactate dehydrogenase, and urinary beta2-Microgl obulin were significantly increased and PaO2 decreased after endoscopi c injection sclerotherapy (p < 0.05). This study shows that endoscopic variceal ligation significantly decreased the adverse effects associa ted with endoscopic injection sclerotherapy in the initial session, an d it is recommended as an alternative to sclerotherapy.