Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: Prospective randomized trial

Background: To evaluate the safety and efficiency of variceal ligation comp ared with endoscopic sclerotherapy, 88 patients with cirrhosis with recent variceal bleeding were randomized to undergo either treatment. Methods: Sclerotherapy was performed using ethanolamine and polidocanol inj ection at 1, 2, and 3 weeks and every 3 weeks thereafter. The Stiegmann-Gof f device was used for variceal ligation at the same intervals. Results: The rate of variceal eradication was the same for both groups, but eradication was accomplished sooner in patients undergoing variceal ligati on (5.3 +/- 1.6 vs. 6.6 +/- 2.4 endoscopic sessions, p < 0.05) and with few er complications (19 vs. 6, p < 0.005). The rate of recurrent bleeding was lower in patients treated by ligation (31% vs. 50%, p < 0.05). After eradic ation, variceal recurrence was more frequent in patients treated by varicea l ligation at 1 and 3 years (47% and 92% vs. 23% and 55%, p < 0.01). Portal hypertensive gastropathy was significantly worse in the patients who had v ariceal ligation (17 patients vs. 6, p < 0.01). Survival and treatment fail ure were similar in both groups. Conclusions: Variceal ligation was superior to sclerotherapy in terms of th e rate of recurrent bleeding and the occurrence of complications but worse with respect to recurrence of varices and the evolution of portal hypertens ive gastropathy. Longterm follow-up studies are required to find out whethe r there are deleterious effects of variceal ligation.