Info

EIS = endoscopic injection sclerotherapy, NS = not significant; SBT = Sengstaken-Blakemore tube.

*Lower in C-risk patients for EIS. TSignificant difference compared with the control. {Excluding encephalopathy.

EIS = endoscopic injection sclerotherapy, NS = not significant; SBT = Sengstaken-Blakemore tube.

*Lower in C-risk patients for EIS. TSignificant difference compared with the control. {Excluding encephalopathy.

provided almost two-fold greater protection against variceal rebleeding than did balloon tamponade and was associated with significantly fewer complications. In one trial, sclerotherapy followed by tamponade was compared with sclerotherapy alone, with no apparent improvement in survival or decrease in rebleeding or complications.

Despite intertrial differences in the type of endoscope, the site of variceal injection, and the sclerosant used, the outcomes (initial control of bleeding, overall mortality, and rebleeding) were fairly uniform. The data from these randomized trials are compiled in Table 27-1 . These studies showed clearly that sclerotherapy is superior to conservative therapy using balloon tamponade as the sole form of treatment for acute

variceal bleeding, with no appreciable increase in the frequency or severity of complications.1 • 1 • 1 • EFFECT OF SCLEROTHERAPY ON EARLY AND LATE SURVIVAL

Although sclerotherapy has been more effective than medical management for stopping acute variceal bleeding and for reducing the risk of late rebleeding, the survival benefits of this form of therapy continue to be questioned. Of the five major randomized clinical trials designed

TABLE 27-2 -- Effects of Sclerotherapy on Long-Term Survival

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