Prospective randomized comparison of sodium tetradecyl sulphate & polidocanol for oesophageal variceal sclerotherapy

Background & objective: A number of sclerosing agents have been tried for s clerotherapy of oesophageal varices. However, none of them have emerged as an ideal agent. Hence, this study was designed to compare the efficacy and safety of sodium tetradecyl sulphate and polidocanol for sclerotherapy of o esophageal varices. Methods: A total of 100 consecutive patients with bleeding oesophageal vari ces were included in the study. Patients with associated gastric varices an d hypersplenism were excluded. Of the 100 patients, 50 received emergency s clerotherapy with either 3 per cent sodium tetradecyl sulphate or 3 per cen t,polidocanol, randomized using the sealed envelope technique. Following co ntrol of bleeding, these patients were included in the elective sclerothera py schedule. The remaining 50 patients with past history of bleeding varice s received elective sclerotherapy. Thus all 100 patients received elective sclerotherapy at 4 weekly intervals. Results: There was no significant difference between the sodium tetradecyl sulphate and polidocanol groups with respect to the control of acute varice al bleeding (100% vs 96%), the mean number of injection sessions (4.5 +/- 0 .3 vs 4.7 +/- 0.4) and the mean amount of scleroscent required (33.3 +/- 2. 7 ml vs 37.0 +/- 3.3 ml) per patient for variceal eradication. The cost of polidocanol required for variceal obliteration was significantly higher tha n that of sodium tetradecyl sulphate (P < 0.001). The use of sodium tetrade cyl sulphate in contrast to polidocanol was associated with a significantly higher incidence of variceal recurrence (11% vs 0%) and other complication s such as oesophageal ulcer (14% vs 2%), retrosternal pain (22% vs 2%), fev er (16% vs 4%), tachycardia (14% vs 2%) and dysphagia (20% vs 6%). Rebleedi ng rate and mortality rate were not significantly different between the two groups. Interpretation & conclusion: Polidocanol is superior to sodium tetradecyl s ulphate as it has lower incidence of complications, even though the drugs a re similar in efficacy in the control of bleeding and obliteration of varic es in long-term.