The currently recommended treatment for acute variceal bleeding is the association of vasoactive drugs and endoscopic therapy.
However, which emergency endoscopic treatment combines better with drugs has not been clarified.
Dr Càndid Villanueva compares the efficacy and safety of variceal ligation and sclerotherapy as emergency endoscopy added to somatostatin.
Patients admitted with acute gastrointestinal bleeding and with suspected cirrhosis received somatostatin infusion for 5 days.
The team of doctors performed endoscopy within 6 hours and those with esophageal variceal bleeding.
|Therapeutic failure occurred in 24% with sclerotherapy vs 10% treated with ligation|
|Journal of Hepatology|
The team randomized 89 receive either sclerotherapy or 90 to ligation.
The doctors found that therapeutic failure occurred in 24% of patients treated with sclerotherapy and in 10% treated with ligation.
Failure to control bleeding occurred in 15% vs 4%, respectively.
The doctors noted that treatment group, shock and hepatic vein pressure gradient above 16mmHg were independent predictors of failure.
Side-effects occurred in 28% of patients receiving sclerotherapy vs 14% with ligation, being serious in 13% vs 4%, respectively.
The team observed that 6-week survival probability without therapeutic failure was better with ligation.
Dr Villanueva's team concludes, “The use of variceal ligation instead of sclerotherapy as emergency endoscopic therapy added to somatostatin for the treatment of acute variceal bleeding significantly improves the efficacy and safety.”