Efficacy of prophylactic sclerotherapy for prevention of a first variceal hemorrhage

The efficacy of prophylactic sclerotherapy is unclear because published studies of prophylactic sclerotherapy have reached conflicting conclusions. Meta-analysis was used to determine the efficacy of prophylactic sclerotherapy of esophageal varices. The meta-analysis included all English-language articles reporting results of randomized controlled trials of prophylactic sclerotherapy in adults. Prophylactic sclerotherapy reduced the 13-month mortality rate by 11% (95% confidence interval, 4%-19%), which represents a 41% relative reduction in mortality rate. Across studies, the mortality rate reductions were positively correlated with the bleeding rate reductions and negatively correlated with complication rates. The pooled mortality reduction remained significant when sensitivity analyses included the interim results from the abstracts and foreign-language articles. Nonetheless, prophylactic sclerotherapy should not be widely applied at present because complication rates are high and less costly treatments are available. Furthermore, all published studies offered more intensive follow-up to treated patients, which may have confounded the results and consistently inflated the benefits of sclerotherapy.