Prospective randomized comparison of sodium tetradecyl sulphate & polidocanol for oesophageal variceal sclerotherapy.

ABSTRACT

BACKGROUND & OBJECTIVE: A number of sclerosing agents have been tried for sclerotherapy of oesophageal varices. However, none of them have emerged as an ideal agent. Hence, this study was designed to compare the efficacy and safety of sodium tetradecyl sulphate and polidocanol for sclerotherapy of oesophageal varices. METHODS: A total of 100 consecutive patients with bleeding oesophageal varices were included in the study. Patients with associated gastric varices and hypersplenism were excluded. Of the 100 patients, 50 received emergency sclerotherapy with either 3 per cent sodium tetradecyl sulphate or 3 per cent polidocanol, randomized using the sealed envelope technique. Following control of bleeding, these patients were included in the elective sclerotherapy schedule. The remaining 50 patients with past history of bleeding varices received elective sclerotherapy. Thus all 100 patients received elective sclerotherapy at 4 weekly intervals. RESULTS: There was no significant difference between the sodium tetradecyl sulphate and polidocanol groups with respect to the control of acute variceal bleeding (100% vs 96%), the mean number of injection sessions (4.5 +/- 0.3 vs 4.7 +/- 0.4) and the mean amount of scleroscent required (33.3 +/- 2.7 ml vs 37.0 +/- 3.3 ml) per patient for variceal eradication. The cost of polidocanol required for variceal obliteration was significantly higher than that of sodium tetradecyl sulphate (P < 0.001). The use of sodium tetradecyl sulphate in contrast to polidocanol was associated with a significantly higher incidence of variceal recurrence (11% vs 0%) and other complications such as oesophageal ulcer (14% vs 2%), retrosternal pain (22% vs 2%), fever (16% vs 4%), tachycardia (14% vs 2%) and dysphagia (20% vs 6%). Rebleeding rate and mortality rate were not significantly different between the two groups. INTERPRETATION & CONCLUSION: Polidocanol is superior to sodium tetradecyl sulphate as it has lower incidence of complications, even though the drugs are similar in efficacy in the control of bleeding and obliteration of varices in long-term.