EMERGENCY BANDING LIGATION VERSUS SCLEROTHERAPY FOR THE CONTROL OF ACTIVE BLEEDING FROM ESOPHAGEAL-VARICES

Active bleeding varices are a great challenge to endoscopists. In this study, we compared the short term efficacy and safety of banding liga tion with injection sclerotherapy in the arresting of active bleeding from esophageal varices. Seventy-one cirrhotic patients with active va riceal bleeding mere randomized to receive banding ligation (37 patien ts) or sclerotherapy (34 patients) immediately after endoscopic examin ations. Primary success rate (bleeding stopped for 72 hours) was 97% i n the ligation group and 76% in the sclerotherapy group (P = .009), Th e efficacy of ligation was similar to sclerotherapy in the control of oozing varices (100% vs. 89%, P = .23), whereas ligation was superior to sclerotherapy in the control of spurting varices (94% vs. 62%, P = .012), The requirement of vasoconstrictors after emergency endoscopic treatment was lower in the ligation group than in the sclerotherapy gr oup (11% vs. 41%, P = .007). Treatment failure within 1 month was 8% i n the ligation group vs. 30% in the sclerotherapy group (P = .02). Blo od transfusion requirements were significantly lower in the ligation g roup than in the sclerotherapy group (3.2 +/- 1.2 vs. 4.5 +/- 1.8 unit s, P < .01), Rebleeding rate within 1 month was 17% in the ligation gr oup and 33% in the sclerotherapy group (P = .19). Significant complica tions were encountered in 5% of the ligation group and 29% of the scle rotherapy group (P = .007). Mortality rates within 1 month were 19% in the ligation group and 35% in the sclerotherapy group (P = .19), Band ing ligation and sclerotherapy were comparable in the arresting of ooz ing varices, whereas ligation was superior to sclerotherapy in the con trol of spurting varices. Patients treated with ligation required fewe r vasoconstrictors and fewer transfusion units than patients treated w ith sclerotherapy. Furthermore, banding ligation was associated with a lower complication rate than sclerotherapy.