Prophylactic Sclerotherapy: Yes or No!

摘要

Controlled trials of endoscopic sclerotherapy for the prevention of the first varicealhemorrhage have given controversial results. We continued a previously reported studyand randomly assigned 141 patients with esophageal varics and no prior gastrointestinalbleeding to either prophylactic sclerotherapy (n=70) or no treatment (n=71). Sclerotherapy was performed until complete eradication of the varices was achieved; recurrentvarics were treated with repeat sclerotherapy. The groups were well balanced in terms ofdemographic and clinical characteristics. Patients in both groups who bled from varicesreceived sclerotherapy whenever possible.During a median follow-up of 56 months, variceal bleeding occurred in 7% insclerotherapy patients and 44% on control patients (p< 0.01). In the sclerotherapygroup 59% died, and in the control group 51% (n.s.). In both groups, the mortality rateincreased with the severity of liver function impairment. Sclerotherapy was not found toimprove survival in patients, irrespective of the etiology of cirrhosis (alcoholic ornonalcoholic) or variceal size (low-grade or high-grade). We conclude that sclerotherapyis a suitable method to reduce the occurrence of the first variceal hemorrhage, but it doesnot appear to have an effect on survival.