Improved survival in variceal hemorrhage with emergent sclerotherapy

Over a 2-yr period (1984-1985) we performed emergent endoscopic injection sclerotherapy (EIS) within 12 h in 25 consecutive episodes of variceal hemorrhage (VH). The outcome was compared to the preemergent period (1982-1984) when 22 episodes of VH were treated first with vasopressin and balloon tamponade, and then by EIS, in cases which failed to resolve. In those with decompensated liver disease, average transfusions dropped from 12.3 to 7.1 units of blood. Continued bleeding decreased from 53% to 13% and mortality from 47% to 13%. Persons with compensated liver disease had fewer recurrent bleeding episodes, and tended toward decreased transfusion requirements and mortality with EIS. Our experience suggests that emergent EIS is the treatment of choice for acute VH.