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Updated: Jan 28, 2026
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
Prophylactic sclerotherapy in high-risk cirrhotics selected by endoscopic criteria. A multicenter randomized
R De Franchis1, M Primignani, P G Arcidiacono
1Istituto di Medicina Interna, University of Milan, Italy.
Insights
Prophylactic sclerotherapy does not prevent first-time variceal bleeding in cirrhosis patients. However, this treatment may reduce bleeding-related mortality in high-risk individuals.
Area of Science:
- Hepatology
- Gastroenterology
Background:
- Variceal hemorrhage is a serious complication of cirrhosis.
- Previous studies on sclerotherapy for preventing first variceal bleeding have yielded conflicting results.
Purpose of the Study:
- To evaluate the efficacy of prophylactic sclerotherapy in preventing the first variceal hemorrhage in patients with cirrhosis.
Main Methods:
- A randomized controlled trial involving 106 cirrhotic patients with high-risk varices and no prior bleeding history.
- Patients were assigned to either sclerotherapy (55) or a control group (51).
- Sclerotherapy was administered at intervals until eradication, with follow-up endoscopies every 6 months.
Main Results:
- Variceal bleeding occurred in 34.5% of the sclerotherapy group and 35.4% of the control group (P = NS).
- Overall mortality was not significantly different between groups (34.5% vs. 50%).
- However, bleeding-related mortality was lower in the sclerotherapy group (36.8%) compared to controls (64.7%, P < 0.05).
Conclusions:
- Prophylactic sclerotherapy does not reduce the incidence of first variceal bleeding in cirrhotic patients.
- A trend suggests lower bleeding-related mortality in patients receiving prophylactic sclerotherapy.
Abstract:
Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results. In the present study, 106 cirrhotics were randomized to sclerotherapy (55 patients) or control group (51 patients). Admission criteria were no history of previous variceal bleeding and the presence of high-risk varices, i.e., a variceal score less than or equal to 0 according to Beppu et al. Sclerotherapy sessions were performed at time zero, 7 days, 30 days, and then monthly until eradication. Follow-up endoscopies were performed at 6-month intervals thereafter. Control patients underwent repeat endoscopy at 6-month intervals. Bleeding episodes were treated by sclerotherapy in both groups, whenever possible. Mean follow-up was 24 months. Analysis of the results was performed by the intention-to-treat method. Variceal bleeding occurred in 19 sclerotherapy patients (34.5%) and in 17 controls (35.4%, P = NS). Overall mortality was 34.5% in sclerotherapy patients and 50% in controls (P = NS). Seven of the 19 sclerotherapy patients (36.8%) and 11 of the 17 controls (64.7%) who bled died of hemorrhage (P less than 0.05, log-linear model). It is concluded that prophylactic sclerotherapy does not reduce the incidence of first variceal bleeding in cirrhotics. However, there seems to be a trend toward a lower bleeding-related mortality in sclerotherapy patients than in controls.
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