Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices: a prospective randomized study

Background: We devised a new combined method of endoscopic variceal ligatio n and injection sclerotherapy, namely, endoscopic scleroligation, for the t reatment of esophageal varices. The aim of this prospective randomized tria l was to compare endoscopic scleroligation with endoscopic variceal ligatio n alone with regard to efficacy, complications, variceal recurrence, and su rvival. Methods: Fifty-one patients with cirrhosis and esophageal varices were rand omly assigned to be treated by endoscopic scleroligation (n = 25) or endosc opic variceal ligation (n = 26). In the initial session in the endoscopic s cleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterat e the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endosco pic injection sclerotherapy was performed with 1% polidocanol. In the endos copic variceal ligation group, that procedure was performed in all treatmen t sessions. Results: Both methods were equally effective in achieving complete eradicat ion of esophageal varices. Among the cases in which complete eradication wa s achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) (p < 0.01). The survi val rates and incidences of treatment-related complications have been simil ar among patients treated by both methods. Conclusions: Endoscopic scleroligation is superior to endoscopic variceal l igation in preventing variceal recurrence.