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Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.
N Engl J Med. 1992 Jun 04; 326(23):1527-32.NEJM

Abstract

BACKGROUND

Endoscopic sclerotherapy is an accepted treatment for bleeding esophageal varices, but it is associated with substantial local and systemic complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, may be safer. We compared the effectiveness and safety of the two techniques.

METHODS

In this randomized trial we compared endoscopic sclerotherapy and endoscopic ligation in 129 patients with cirrhosis who had proved bleeding from esophageal varices. Sixty-five patients were treated with sclerotherapy, and 64 with ligation. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications and recurrences of bleeding, the number of treatments needed to eradicate varices, and survival.

RESULTS

Active bleeding at the first treatment was controlled by sclerotherapy in 10 of 13 patients (77 percent) and by ligation in 12 of 14 patients (86 percent). Slightly more sclerotherapy-treated patients had recurrent hemorrhage during the study (48 percent vs. 36 percent for the ligation-treated patients, P = 0.072). The eradication of varices required a lower mean (+/- SD) number of treatments with ligation (4 +/- 2 vs. 5 +/- 2, P = 0.056) than with sclerotherapy. The mortality rate was significantly higher in the sclerotherapy group (45 percent vs. 28 percent, P = 0.041), as was the rate of complications (22 percent vs. 2 percent, P less than 0.001). The complications of sclerotherapy were predominantly esophageal strictures, pneumonias, and other infections.

CONCLUSIONS

Patients with cirrhosis who have bleeding esophageal varices have fewer treatment-related complications and better survival rates when they are treated by esophageal ligation than when they are treated by sclerotherapy.

Authors+Show Affiliations

Department of Surgery, University of Colorado, Denver.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

1579136

Citation

Stiegmann, G V., et al. "Endoscopic Sclerotherapy as Compared With Endoscopic Ligation for Bleeding Esophageal Varices." The New England Journal of Medicine, vol. 326, no. 23, 1992, pp. 1527-32.
Stiegmann GV, Goff JS, Michaletz-Onody PA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med. 1992;326(23):1527-32.
Stiegmann, G. V., Goff, J. S., Michaletz-Onody, P. A., Korula, J., Lieberman, D., Saeed, Z. A., Reveille, R. M., Sun, J. H., & Lowenstein, S. R. (1992). Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. The New England Journal of Medicine, 326(23), 1527-32.
Stiegmann GV, et al. Endoscopic Sclerotherapy as Compared With Endoscopic Ligation for Bleeding Esophageal Varices. N Engl J Med. 1992 Jun 4;326(23):1527-32. PubMed PMID: 1579136.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. AU - Stiegmann,G V, AU - Goff,J S, AU - Michaletz-Onody,P A, AU - Korula,J, AU - Lieberman,D, AU - Saeed,Z A, AU - Reveille,R M, AU - Sun,J H, AU - Lowenstein,S R, PY - 1992/6/4/pubmed PY - 1992/6/4/medline PY - 1992/6/4/entrez SP - 1527 EP - 32 JF - The New England journal of medicine JO - N Engl J Med VL - 326 IS - 23 N2 - BACKGROUND: Endoscopic sclerotherapy is an accepted treatment for bleeding esophageal varices, but it is associated with substantial local and systemic complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, may be safer. We compared the effectiveness and safety of the two techniques. METHODS: In this randomized trial we compared endoscopic sclerotherapy and endoscopic ligation in 129 patients with cirrhosis who had proved bleeding from esophageal varices. Sixty-five patients were treated with sclerotherapy, and 64 with ligation. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications and recurrences of bleeding, the number of treatments needed to eradicate varices, and survival. RESULTS: Active bleeding at the first treatment was controlled by sclerotherapy in 10 of 13 patients (77 percent) and by ligation in 12 of 14 patients (86 percent). Slightly more sclerotherapy-treated patients had recurrent hemorrhage during the study (48 percent vs. 36 percent for the ligation-treated patients, P = 0.072). The eradication of varices required a lower mean (+/- SD) number of treatments with ligation (4 +/- 2 vs. 5 +/- 2, P = 0.056) than with sclerotherapy. The mortality rate was significantly higher in the sclerotherapy group (45 percent vs. 28 percent, P = 0.041), as was the rate of complications (22 percent vs. 2 percent, P less than 0.001). The complications of sclerotherapy were predominantly esophageal strictures, pneumonias, and other infections. CONCLUSIONS: Patients with cirrhosis who have bleeding esophageal varices have fewer treatment-related complications and better survival rates when they are treated by esophageal ligation than when they are treated by sclerotherapy. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/1579136/Endoscopic_sclerotherapy_as_compared_with_endoscopic_ligation_for_bleeding_esophageal_varices_ L2 - https://www.nejm.org/doi/10.1056/NEJM199206043262304?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -