PROPHYLACTIC VERSUS EMERGENCY SCLEROTHERAPY OF LARGE ESOPHAGEAL-VARICES PRIOR TO LIVER-TRANSPLANTATION

From January 1985 through July 1987, adult patients accepted for liver transplantation with large esophageal varices were enrolled in a stud y evaluating the use of prophylactic vs emergency sclerotherapy. Six h undred forty-eight subjects received prophylactic sclerotherapy, and 1 72 received emergent sclerotherapy. Esophageal stricture formation was increased 12.9-fold (P < 0.001), esophageal perforation 6.4-fold (P < 0.005), and postsclerotherapy bleeding esophageal ulcers 3.7-fold (P < 0.001) in those receiving emergency sclerotherapy as opposed to prop hylactic sclerotherapy. These differences were even greater if the num ber of sclerotherapy sessions rather than the number of patients was u sed as the denominator for the comparisons. In total, 19.6% of emergen cy sclerotherapy cases were associated with an untoward outcome of scl erotherapy; only 1.9% of cases receiving prophylactic sclerotherapy ex perienced an untoward outcome (P < 0.001). These data demonstrate that emergency sclerotherapy is associated with a greater prevalence of co mplications and support earlier studies that show that sclerotherapy p revents variceal bleeding over the short term. The data also suggest t hat when applied to patients with large varices awaiting orthotopic li ver transplantation, it enhances the chance of a patient surviving to be transplanted by preventing a variceal bleed and the spiral of liver failure and death that frequently follows an episode of acute varicea l bleeding.