A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal varices.

BACKGROUND AND STUDY AIMS: Endoscopic ligation (EVL) and endoscopic variceal sclerotherapy (EVS) are known to be equally effective in eradicating bleeding esophageal varices in patients with hepatic cirrhosis, but the long-term safety and efficacy of the two techniques have not been clearly established. The aim of this study was to determine the relative frequency of rebleeding, recurrence of varices, and survival after treatment with the two techniques during a relatively long follow-up period. PATIENTS AND METHODS: A total of 111 patients without bleeding at the index endoscopy were randomly assigned to either EVL (n = 57) or EVS (n = 54). After eradication of the varices, the patients received endoscopic examinations every three months and for each episode of rebleeding. RESULTS: The mean follow-up periods were 534 +/- 42 days in the EVS group and 496 +/- 40 days in the EVL group. The two techniques were equally effective in eradicating varices (93% in EVL group and 92.5% in EVS group). The mean number of sessions required to obtain eradication was slightly lower (mean +/- SE) in the EVL group (3.5 +/- 0.1 vs. 4.0 +/- 0.1, P = 0.004), while the time required for eradication was longer (33.8 +/- 2.1 vs. 27.3 +/- 1.4, P = 0.01). The comparison of the Kaplan-Meier estimates of survival and time to first rebleeding did not show any statistically significant differences between the two groups. The rate of complications was significantly higher in the EVS group than in the EVL group (31% vs. 11%, P = 0.001), while the rate of recurrent varices during follow-up was higher in the EVL group (30% vs. 13%, P = 0.03). CONCLUSIONS: While the two techniques are equally effective, ligation treatment shows greater advantages in the short-term follow-up, but is associated with more frequent recurrence of varices in the longer term. These two aspects should be considered for evaluation in the cost-benefit ratio and quality of life analysis. All patients should have frequent endoscopic evaluations (every three or four months) throughout the first year of follow-up.

Evaluation of undiluted N-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices.

BACKGROUND AND STUDY AIMS: Endoscopic obliteration of upper gastrointestinal tract varices using N-butyl-2-cyanoacrylate has been proposed by some authors. The aim of the present study was to evaluate prospectively the efficacy and safety of this technique, using the undiluted substance, in obtaining hemostasis of bleeding upper gastrointestinal tract varices, as well as definitive eradication of varices located in the gastric fundus and duodenum. PATIENTS AND METHODS: We carried out variceal injections of N-butyl-2-cyanoacrylate in 80 patients (51 males, 29 females, mean age 68 years, range 19-80) with upper gastrointestinal tract varices. In 24 patients, the varices were located in the esophagus, in 54 in the gastric fundus, and in the remaining two they were in the duodenum. Forty-eight patients were treated for active variceal bleeding, and the other 32 were treated electively. RESULTS: Hemostasis was achieved in 43 of the 48 patients (89.6%) treated for active variceal bleeding. Eradication was obtained in 49 of the 56 patients (87.5%) with gastric or duodenal varices. Overall complications occurred in 11 patients (10.4%). In two patients, embolization was found, and in a further two patients it was clinically suspected, but could not be proved. Ten patients (12.5%) died during the treatment period, six due to uncontrolled bleeding, two due to rebleeding, and two due to liver failure. CONCLUSIONS: Endoscopic injection of N-butyl-2-cyanoacrylate appears to be both safe and effective in the treatment of bleeding gastrointestinal tract varices. The relative value of the undiluted substance versus the diluted one should be further evaluated.

[Clinical evaluation of the use of somatostatin (VAL 787) in the treatment of upper digestive hemorrhage]. / Valutazione clinica dell'uso della somatostatina (VAL 787) nel trattamento delle emorragie digestive superiori.

Personal experience with 30 patients treated with Somatostatin for upper gastrointestinal bleeding is reported. The conclusion is drawn that this drug, reducing chloro-peptic secretion and hepatic portal blood flow, can reduce and control bleeding and postpone the surgical operation, which has a high rate of mortality.