PROSPECTIVE RANDOMIZED TRIAL OF ENDOSCOPIC SCLEROTHERAPY VERSUS VARICEAL BAND LIGATION FOR ESOPHAGEAL-VARICES - INFLUENCE ON GASTROPATHY, GASTRIC VARICES AND VARICEAL RECURRENCE

Background/Aims: Endoscopic variceal ligation and endoscopic sclerothe rapy are both recommended for the prevention of variceal rebleeding, T o compare their efficacy their influence on gastric varices and the de velopment of portal gastropathy, 95 patients with variceal bleeding we re studied, Methods: The patients were randomized to receive weekly en doscopic sclerotherapy using alcohol (n=48) or endoscopic variceal lig ation (n=47), The endoscopic sclerotherapy and endoscopic variceal lig ation groups were comparable in etiology, severity of liver disease an d grade of varices, Results: In the arrest of acute bleed, endoscopic sclerotherapy and endoscopic variceal ligation were comparable (86% vs , 80%, p=ns), Endoscopic variceal ligation as compared to endoscopic s clerotherapy, obliterated esophageal varices in fewer sessions (4.1+/- 1.2 vs, 5.2+/-1.8, p<0.01) and a shorter time (4.4+/-1.3 vs, 6.9+/-3.4 wk, p<0.01), Three (6.4%) patients bled after endoscopic variceal lig ation and 10 (20.8%) after endoscopic sclerotherapy (p<0.05), The actu arial percentage of variceal recurrence during a follow-up of 8.5+/-4. 4 months, was higher after endoscopic variceal ligation than endoscopi c sclerotherapy (28.7% vs 7.5%, p<0.05). Esophageal stricture formatio n after endoscopic sclerotherapy occurred in five (10.4%) patients, bu t in none after endoscopic variceal ligation, Significantly more patie nts developed gastropathy after endoscopic sclerotherapy than ligation (20.5% us, 2.3%; p=0.02), Endoscopic sclerotherapy (52%) and endoscop ic variceal ligation (59%) were equally effective in obliterating the lesser curve gastric varices, Six patients: died: three in each group, Conclusions: (i) Endoscopic sclerotherapy and endoscopic variceal lig ation were equally effective in controlling acute bleed; (ii) endoscop ic ligation achieved variceal obliteration faster and in fewer treatme nt sessions; (iii) endoscopic variceal ligation had a significantly lo wer rate of development of portal gastropathy and rebleeding, (iv) whi le both techniques influenced gastric varices equally there was signif icantly higher esophageal variceal recurrence after endoscopic varicea l ligation than sclerotherapy.