Patients who have bled from
varices remain at risk for rebleeding. There is interest in methods that would enable rapid eradication of
varices. The present trial was designed to study whether combining
ligation with
sclerotherapy will allow quicker eradication of
varices than either modality alone. Patients with
bleeding esophageal varices were randomized into
ligation or combination
therapy groups. Patients in the
ligation group were treated with endoscopic rubber band
ligation alone. In combination group patients, each variceal column was ligated distally and 1 mL of
ethanolamine was injected proximal to each ligated site. Subsequent treatment sessions were at 7- to 14-day intervals until
varices were eradicated. The clinical and endoscopic characteristics of 25 patients in the
ligation group were similar to those of 22 patients in the combination group. Follow-up was up to 30 months. Active
bleeding was controlled in 100% of patients in the
ligation group and 75% of those in combination group (P = NS). It took 3.3 +/- .4 (range, 1-7) sessions to eradicate
varices with
ligation and 4.1 +/- .6 (1-7) with combination
therapy (P = NS). Survival (four deaths in
ligation group, 8 in combination group), rebleeding rate (25% vs. 36%), and
varix recurrence (16% vs. 23%) also were similar. There were more complications with combination
therapy, including deep
ulcers (65% vs. 20%; P < .05);
dysphagia (30% vs. 0%; P < .05), with three
strictures requiring dilation; and
pain (30% vs. 10%; P = NS). Our results show that
sclerotherapy combined with
ligation offers no benefit over
ligation alone. The higher complication rate with combination
therapy does not warrant this approach.