Endoscopic ligation vs. sclerotherapy in adults with extrahepatic portal venous obstruction: a prospective randomized study

Background: Endoscopic sclerotherapy is a well-established treatment for bleeding esophageal varices, although it has a substantial complication rate. A prospective randomized trial was conducted to determine whether endoscopic variceal ligation is safer and more effective than sclerotherapy in adults with bleeding esophageal varices because of extrahepatic portal venous obstruction. Methods: Thirty-six patients underwent sclerotherapy and 37 had band ligation. Results: Ligation and sclerotherapy were equally effective for achieving variceal eradication (94.6% vs. 91.7%, respectively; p = 0.67). However, ligation achieved eradication with fewer endoscopic sessions (3.7 [1.2] vs. 7.7 [3.3]; p < 0.0001) and within a shorter time interval (50.1 [17.7] days vs. 99 [54.8] days; p < 0.0001). In the ligation group, recurrent bleeding was less frequent (2.7% vs. 19.4%; p = 0.028; however, Bonferroni correction for multiple testing removes this significance) and the rate of major complications was lower (2.7% vs. 22.2%; p = 0.014). Total cost per patient was significantly higher in the sclerotherapy vs. the ligation group ($216.6 [71.8] vs. $182.6 [63.4]; p = 0.035). During the follow-up period after variceal eradication, no significant differences were found between the sclerotherapy and the ligation groups with respect to recurrent bleeding (3% vs. 2.9%; p = 1.0), esophageal variceal recurrence (9.1% vs. 11.4%; p = 1.0), and formation of new gastric varices (9.1% vs. 14.3%; p = 0.51). Conclusions: Variceal band ligation is superior to sclerotherapy, because it is less costly and achieves variceal eradication more quickly; with lower relative frequencies of recurrent variceal bleeding and complications.