ENDOSCOPIC LIGATION COMPARED WITH SCLEROTHERAPY FOR THE TREATMENT OF BLEEDING ESOPHAGEAL-VARICES

Objective: Comparison of the safety and efficacy of endoscopic sclerot herapy and ligation for the treatment of bleeding esophageal varices. Design: Randomized, controlled trial. Setting: An urban county hospita l. Patients: Patients with clinically severe bleeding from esophageal varices. Intervention: A total of 77 patients were randomly assigned t o receive sclerotherapy or ligation at the initial endoscopic examinat ion. Treatment was repeated weekly until variceal obliteration was ach ieved. After eradication, patients had endoscopic examinations every 3 months or for any episode of rebleeding. Recurrent varices were treat ed with the originally assigned form of endoscopic therapy. Measuremen ts: Patients were assessed for further bleeding, for transfusion requi rements, for time in hospital, for variceal eradication, for number of treatment sessions required, for complications, for treatment failure , and for risk of death. Results: Rebleeding tended to be less frequen t with ligation than with sclerotherapy: 10 of 38 (26%) compared with 17 of 39 (44%) (difference, 17% [95% CI, -4% to 38%]), but results in the two groups were comparable for blood transfusions, for length of h ospital stay, and for risk of death. Comparison of Kaplan-Meier estima tes of time to rebleeding and death showed no statistical differences between treatments. Complications were less common in the ligation gro up: fewer patients in the ligation group had esophageal strictures (0 of 38 compared with 13 of 39 [33%]; P < 0.001) and had complicated eso phageal ulcers (1 of 38 [2.6%] compared with 6 of 39 [15%]; P = 0.11). In addition, fewer ligation treatments were required to achieve varic eal eradication (4.1 +/- 0.3 compared with 6.2 +/- 0.4; P < 0.001). Co nclusion: Endoscopic ligation causes statistically fewer local complic ations than sclerotherapy and achieves variceal eradication more rapid ly. Ligation is a viable alternative to sclerotherapy and may have som e advantages as a treatment for bleeding esophageal varices.