Adjuvant sclerotherapy after ligation for the treatment of esophageal varices: a prospective, randomized long-term study

Background: To assess the efficacy of adjuvant sclerotherapy after banding for the treatment of esophageal varices, a randomized trial was carried out of endoscopic variceal ligation (EVL) alone with sequential sclerotherapy versus sequential ligation-sclerotherapy (SLS) after banding with respect t o variceal eradication, associated complications, and recurrence of varices . Methods: One hundred patients qualified for this study. Fourteen patients w ere not included for the following reasons: 6 chose not to participate, 4 h ad fundal varices, and 4 had some form of cancer, Of the remaining 86 patie nts in the study, 42 underwent EVL alone and the other 44 SLS, Variceal lig ation was begun in the region of the gastroesophageal junction, with subseq uent ligatures applied cephalad 3 to 5 cm; ligation was repeated every 2 we eks until variceal obliteration. For SLS, ligation was also begun in the re gion of the gastroesophageal junction and repeated until varices were reduc ed to F1 size, Subsequently, these patients underwent sclerotherapy with be tween 6 and 8 mL of sodium tetradecyl sulfate (free hand technique). Results: No significant differences were found between EVL alone and SLS wi th regard to variceal eradication, development of associated complications, and recurrent bleeding during a follow-up of 2 years. The probability of v ariceal recurrence requiring further treatment after 1 year was 14% for the SLS group and 26% for EVL group patients, Another year later, the probabil ity of variceal recurrence was 24% and 45%, respectively, for the SLS and E VL groups. Conclusions: Because a significantly lower rate of variceal recurrence was found for SLS patients, sequential sclerotherapy followed by ligation to er adicate those varices too small to easily band may be a better procedure.