[Preventive sclerotherapy of esophageal varices with a high risk of hemorrhage: a prospective randomized controlled study]

Abstract

Endoscopic sclerotherapy (ES) is known to be effective in the treatment of bleeding esophageal varices, but the efficacy in the prophylaxis of first variceal bleeding has not been clear yet. The aim of this study was to investigate the frequency of first variceal bleeding, eradication and recurrence of varices, and survival after treatment with ES compared to non-treated control group. A total of 104 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either endoscopic sclerotherapy group--SKL n = 56, or non-treated control group--KON n = 48. After eradication of esophageal varices in SKL group and in all control patients, the endoscopic examination was performed in 3 month intervals. The complete eradication of esophageal varices was achieved in 45 (83%) patients of SKL group. The mean number of sessions required to obtain eradication was 7.8 +/- 2.5. The recurrence of esophageal varices occurred in 9 (17%) patients. Total mortality was significantly lower in SKL patients as compared to controls (21.4% vs. 39.6%; p = 0.047, 95% CI 0.5-35.5). The significant decrease of variceal bleeding we observed in sclerotherapy (21%) versus controls (52%; p = 0.002, 95% CI 13-49%). Serious complications of ES were not observed. Endoscopic sclerotherapy is effective in the prevention of first variceal bleeding and in experienced hand, if the complication rate is low, is able to reduce total mortality of treated patients. The newer endoscopic method, variceal ligation, must be examined in this indication.