Limitations of multiple injection sclerotherapy sessions for acute variceal bleeding

Sixty-six patients with active bleeding (127 episodes) from oesophageal varices treated by balloon-tube tamponade followed by injection sclerotherapy with a rigid endoscope were followed up for at least 1 year and analysed to determine whether the number of acute injection sessions during each hospital admission (87) or any other known parameter of liver function, e.g. Child's grading, affected the outcome. Definitive control of bleeding was achieved with one or two injections during 75 of these admissions (86%) with a mortality rate of 21%. However, the mortality rate in those patients who received three or four injections was 66% and reached 89% when Child's category A patients were excluded. It is concluded that the mortality rate in poor risk patients becomes unacceptably high when more than two injection sessions are required during a single hospital admission. Other methods of treatment, such as emergency portacaval shunting or devascularization procedures, should be instituted in the small subgroup of patients whose variceal bleeding is not controlled by two injection sessions.