Controlled trials of endoscopic
sclerotherapy for the prevention of the first variceal
hemorrhage have given controversial results. We continued a previously reported study and randomly assigned 141 patients with
esophageal varices and no prior gastrointestinal
bleeding to either prophylactic
sclerotherapy (n = 70) or no treatment (n = 71).
Sclerotherapy was performed until complete eradication of the
varices was achieved; recurrent
varices were treated with repeat
sclerotherapy. The groups were well balanced in terms of demographic and clinical characteristics. Patients in both groups who bled from
varices received
sclerotherapy whenever possible. During a median follow-up of 56 months, variceal
bleeding occurred in 7% in
sclerotherapy patients and 44% of control patients (p < 0.01). In the
sclerotherapy group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate increased with the severity of liver function impairment.
Sclerotherapy was not found to improve survival in patients, irrespective of the etiology of
cirrhosis (alcoholic or nonalcoholic) or variceal size (low-grade or high-grade). We conclude that
sclerotherapy is a suitable method to reduce the occurrence of the first variceal
hemorrhage, but it does not appear to have an effect on survival.