Randomized controlled trial of injection sclerotherapy for bleeding oesophageal varices—an interim report

Abstract

Oesophageal varices are the commonest cause of acute upper gastrointestinal bleeding in Egypt, due to the prevalence not only of schistosomiasis but also chronic hepatitis. Poor results of conventional treatment and shunt surgery led us to evaluate injection sclerotherapy, using fibreoptic endoscopy. In a controlled trial, 108 patients were randomly allocated to injection sclerotherapy or to conventional treatment (medical measures, with modified splenectomy and oesophagogastric devascularization in selected cases). We report the results in the first 108 patients, with a follow-up of 1-35 months. Fifty-three patients received injection sclerotherapy; 5 died (2 of recurrent bleeding) and 5 others had recurrent bleeding but were controlled by further injections. Thirty-six of the 55 control patients underwent surgery; 5 died (2 of recurrent bleeding) and 2 others developed recurrent bleeding. Further bleeding occurred in 12 of the 19 patients who were managed by medical measures alone, with 7 dying. These early results indicate that injection sclerotherapy can be effective in urgent and elective situations and that it appears to have advantages over conventional medical and surgical treatments.

Endoscopic Sclerosis and Esophageal Balloon Tamponade in Acute Hemorrhage From Esophagogastric Varices: A Prospective Controlled Randomized Trial

“…Other controlled trials of ES have dealt with elective sclerotherapy, i.e., in patients in whom the active bleeding had been controlled, and ES was begun at some later time (4,9,18,19). In each of these investigations, the ES decreased the rate of recurrent bleeding and showed at least a trend toward improved survival.…”

Endoscopic Injection Sclerotherapy in Patients With Bleeding Esophageal Varices: A Retrospective Analysis

“…The complications arising from sclerotherapy range from substernal pain 36 , 37 , 39 – 41 ) , esophageal bleeding 40 – 42 ) , ulceration and sloughing of the esophageal mucosa 37 , 40 – 42 ) , perforation with periesophageal leakage 36 , 37 , 42 ) , thoracic empyema 36 ) and pleural effusion 39 ) , to delayed esophagela necrosis occurring five to 14 days later 15 , 36 ) , broncho-esophageal fistula 44 ) , late esophageal stenosis 1 , 2 , 5 , 10 , 16 ) , periesophageal granuloma and portal vein thrombosis 45 , 46 ) .…”

Endoscopic Sclerosis of Esophageal Varices

“…Yassin and Sher if [57] reported a rebleed ing rate of 13% in 51 patients receiving scle rotherapy and 29% in 55 patients managed by other means (p < 0.05). A survival ad vantage could be attributed to sclerotherapy (mortality 9 versus 24%, p < 0.05).…”