Comparative study of endoscopic band ligation and sclerotherapy for treatment of oesophageal varices in cirrhotic patients

Abstract

A prospective randomized study was done comparing endoscopic band ligation and sclerotherapy for the treatment of oesophageal varices. Hundred fifty cirrhotic patients with history of bleeding from varices were included in the study. Seventy-five patients got sclerotherapy and 75 got band ligation of varices. Both sclerotherapy and band ligation were continued till obliteration of varices. Clinical as well as the biochemical parameters of the two groups of patients and the severity of the liver diseases were similar in both groups. The mean period of follow up was 337 days for sclerotherapy group and 376 days for band ligation group. The mean time to eradicate the varices was significantly shorter with banding (35+/-4.1 vs 75+/-6.5, p<0.001). The mean number of treatment sessions was significantly less with banding (2.3+/-3.1 vs 5.2+/-2.1, p<.001). Rebleeding was significantly more with sclerotherapy (20 vs. 8 with p<0.01). The variables significantly associated with rebleeding were hypoalbuminaemia (p<.01), and active bleeding at index endoscopy (p<0.001). Different complications like oesophageal ulcer, bleeding from ulcer and the symptoms of oesophageal stricture were more in the sclerotherapy group. There was no significant difference in survival between the two groups. Number of blood transfusions and duration of hospitalization were less in band ligation group. There was no difference in terms of recurrence between the two groups. From the study we suggest that band ligation has less local complications and causes earlier eradication of varices than sclerotherapy. Therefore, band ligation may be the first choice of therapy for oesophageal varices.