Prophylactic versus emergency sclerotherapy of large esophageal varices prior to liver transplantation

Abstract

From January 1985 through July 1987, adult patients accepted for liver transplantation with large esophageal varices were enrolled in a study evaluating the use of prophylactic vs emergency sclerotherapy. Six hundred forty-eight subjects received prophylactic sclerotherapy, and 172 received emergent sclerotherapy. Esophageal stricture formation was increased 12.9-fold (P < 0.001), esophageal perforation 6.4-fold (P < 0.005), and postsclerotherapy bleeding esophageal ulcers 3.7-fold (P < 0.001) in those receiving emergency sclerotherapy as opposed to prophylactic sclerotherapy. These differences were even greater if the number of sclerotherapy sessions rather than the number of patients was used as the denominator for the comparisons. In total, 19.6% of emergency sclerotherapy cases were associated with an untoward outcome of sclerotherapy; only 1.9% of cases receiving prophylactic sclerotherapy experienced an untoward outcome (P < 0.001). These data demonstrate that emergency sclerotherapy is associated with a greater prevalence of complications and support earlier studies that show that sclerotherapy prevents variceal bleeding over the short term. The data also suggest that when applied to patients with large varices awaiting orthotopic liver transplantation, it enhances the chance of a patient surviving to be transplanted by preventing a variceal bleed and the spiral of liver failure and death that frequently follows an episode of acute variceal bleeding.

Terlipressin vs. Somatostatin in bleeding esophageal varices: A controlled, double-blind study

“…Prindiville et al (62) found a more frequent incidence of rebleeding after sclerotherapy when the procedure was performed during the acute bleeding (50%) rather than as elective treatment (30%). Elective sclerotherapy may be performed more easily and more safely than the emergency procedure during bleeding (63). In this study, bleeding was initially stopped and controlled by the vasoactive drugs plus balloon tamponade in 96%.…”