Comparison of endoscopic variceal sclerotherapy with sequential endoscopicband ligation plus low-dose sclerotherapy for secondary prophylaxis of variceal hemorrhage: a prospective randomized study

Background: Endoscopic variceal sclerotherapy and band ligation both have c ertain limitations such as, respectively, esophageal complications and earl y recurrence of varices. Methods: From February 1994 to March 1996, all consecutive patients with po rtal hypertension due to either cirrhosis or noncirrhotic portal fibrosis a nd a history of variceal bleeding were included in a prospective study and randomly assigned to receive either endoscopic variceal sclerotherapy alone or endoscopic variceal band ligation plus low-dose endoscopic variceal scl erotherapy. Results: Of 69 patients, 34 were randomly assigned to receive endoscopic va riceal sclerotherapy alone; 35 received endoscopic variceal band ligation p lus endoscopic variceal sclerotherapy. Complete variceal eradication rates (85% vs. 80%) and the number of endoscopic sessions required for eradicatio n (6.61 +/- 2.94 vs. 7.85 +/- 3.31) were similar in the endoscopic variceal sclerotherapy and endoscopic variceal band ligation plus endoscopic varice al sclerotherapy groups, respectively. The mean volume of sclerosant requir ed in the combined group (54.94 +/- 33.74 mL) was significantly less than t hat in the endoscopic variceal sclerotherapy group (81.91 +/- 34.80 mL). Th e complication and recurrent bleeding rates were significantly higher in th e endoscopic variceal sclerotherapy group than those in the combined group (20% and 16% vs. 3% and 3%, respectively). Conclusions: Both endoscopic variceal sclerotherapy and endoscopic variceal band ligation plus endoscopic variceal sclerotherapy were comparable in er adicating varices but the combined technique was associated with significan tly lower complication and recurrent bleeding rates.