Abstract
Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage
in cirrhotics have given conflicting results, in spite of an initial positive controlled
trial. We designed therefore a new study in which only 89 of 396 investigated patients
were randomized to sclerotherapy (44 patients) or a control group (45 patients). The
admission criteria were: no history of variceal bleeding, the presence of high risk
varices, i.e., varices of degrees III and IV with minivarices on the surface of them,
and portal pressure over 16 mmHg. Sclerotherapy sessions were performed at 0, 7, 14,
21, and 28 days, until the varices were reduced in size and completely covered by
fibrous tissue. Follow-up endoscopy was performed at four-month and thereafter at
six-month intervals. The control patients underwent repeated clinical investigation
and endoscopy at six-month intervals. Bleeding episodes were treated by emergency
endoscopic sclerotherapy in both groups, whenever possible. The mean follow-up was
33 months. The results were analyzed using Student's t -test and the log-rank test. Variceal bleeding occured in 11 sclerotherapy patients
(25 %) and 34 controls (75.6 %) (p < 0.05). The overall mortality was 25 % (11 patients)
among the sclerotherapy patients and 69 % (31 patients) in the controls (p < 0.01).
Prophylactic endoscopic sclerotherapy was able to prolong survival in Child-Pugh classes
A and B, but not in C. It is concluded that prophylactic endoscopic sclerotherapy
does reduce the incidence of first variceal bleeding in cirrhotic patients, and is
able to prolong survival if only high-risk patients are selected and the treatment
is performed by endoscopic experts.
