Comparative evaluation of combined endoscopic variceal ligation together with low volume sclerotherapy versus sclerotherapy or band ligation alone for bleeding esophageal varices

ABSTRACT

The subjects of this study were forty six patients presenting with upper GI bleeding due to esophageal varices with unstable vital signs or blood transfusion of >/ 2 units. These patients were randomly assigned to intravariceal sclerotherapy [5% ethanolamine oleate], variceal ligation or combined endoscopic variceal ligation and low volume endoscopic sclerotherapy after resuscitation. Patients had therapy at initial endoscopy and then had weekly sessions until obliteration then follow-up at three months interval. The number of sessions, rebleeding, complications, and treatment failure were reported. Control of active bleeding was accomplished by sclerotherapy in 15 of 17 [88.2%], by ligation in 12 of 15 [80%], and by combined modality in 12 of 14 [85.7%]. Recurrent bleeding was insignificantly lower in both ligation and comibned modality groups. The number of sessions needed for variceal obliteration were significantly lower in both ligation and combined modality groups [4.2 +/- 0.5 and 3.2 +/- 0.6 vs. 6.2 +/- 0.7, P <0.05]. Moreover, the complication rate was significantly higher in the sclerotherapy group. It was also concluded that combination endoscopic variceal ligation together with low volume sclerotherapy results in rapid eradication of esophageal varices with low incidence of complications