ENDOSCOPIC SCLEROTHERAPY WITH FIBRIN GLUE AS COMPARED WITH POLIDOCANOL TO PREVENT EARLY ESOPHAGEAL VARICEAL REBLEEDING

Background/Aims: Endoscopic sclerotherapy is of proven benefit for pat ients after esophageal variceal bleeding, but is associated with subst antial local and systemic complications. Since fibrin glue is a promis ing agent for endoscopic sclerotherapy of esophageal varices, we compa red its safety and efficacy in patients after esophageal variceal blee ding. Patients and Methods: In a randomized, controlled trial, 36 pati ents with an acute episode of variceal bleeding were endoscopically tr eated with either polidocanol (18 patients) or fibrin glue (18 patient s) by intravariceal injections within 12 h of admission. Tissue compat ibility, incidence of various complications, episodes of rebleeding an d overall survival rates were investigated. Results: Rebleeding, espec ially from enrollment to day 28, was less common in the fibrin group ( p=0.046), and all patients treated with fibrin glue survived for more than 28 days, whereas five patients treated with polidocanol died with in this period. The incidence of sclerotherapy-induced ulcers was sign ificantly lower in the fibrin group than in the polidocanol group (p=0 .001), and major complications such as perforation or ulcer bleeding w ere observed only in the polidocanol group. There were not complicatio ns in any group due to activation of systemic coagulation, fibrinolysi s or clinically relevant pulmonary embolization. Conclusions: We concl ude that fibrin glue is an efficient and safe agent for endoscopic scl erotherapy of bleeding esophageal varices, especially in the immediate posthemorrhagic period.