Endoscopic variceal ligation versus endoscopic variceal ligation and endoscopic sclerotherapy: a prospective randomized study

To compare endoscopic variceal ligation (EVL) with a combination of EVL and endoscopic scelerotherapy (EST) in the secondary prophylaxis of esophageal variceal bleeding.

Fifty patients with esophageal varices due to cirrhosis of the liver (38), noncirrhotic portal fibrosis (7), or extrahepatic portal venous obstruction (5) were included in the study. These 50 patients were randomized to receive either EVL alone or a combination of EVL and EST for variceal eradication. Twenty-one patients received EVL alone (group A), and 23 patients received EVL and EST (group B). In group B, EVLs were performed until the varices were reduced to grade II size, and, subsequently, these patients underwent low-dose sclerotherapy with 1% polidocanol until variceal eradication was achieved.

Combined EVL and EST treatment eradicated the varices in a significantly greater number of patients then EVL alone (87% vs. 24%; p < 0.05). However, significantly more endoscopic sessions were required with combined treatment than with EVL alone (5.87 +/- 2.32 vs. 4.28 +/- 1.82; p < 0.05). Rebleeding episodes before variceal eradication were similar in the two groups (19% vs. 22%). The complications were similar in both the EVL and the EVL-plus-EST group, ie., deep ulcers (16% vs. 20%), transient dysphagia (20% vs. 32%), and stricture (4% vs. 8%).

Thus, combined EVL and EST treatment eradicates varices in a significantly larger number of patients than EVL alone, with no extra complications.