Prophylactic Endoscopic Sclerosing Treatment of the Esophageal Wall in Varices - A Prospective Controlled Randomized Trial

TLDR

A randomized controlled trial from 1978‑1980 compared conservative treatment with prophylactic sclerotherapy in 71 cirrhotic patients with esophageal varices, selecting participants based on variceal grade, erosions, and coagulation factors. Prophylactic sclerotherapy significantly lowered bleeding and death rates versus conservative care, confirming the predictive criteria and extending survival in patients with erosions or poor coagulation reserve.

Abstract

From January 1, 1978 to January 1, 1980 a controlled randomized trial comparing conservative treatment with prophylactic sclerotherapy of esophageal varices prior to hemorrhage was carried out. In all 71 patients liver cirrhosis was histologically confirmed. The two randomly assigned groups were comparable. Indications of endoscopic treatment were the existence of varices III-IV bearing erosions, varices II-IV without erosions but coagulation factors below 30%, or both. Six patients left the trial. In group Ia -- treatment by conservative means -- a high rate of variceal bleeding and death was observed. Comparing these results with those of group Ib treated by sclerotherapy, bleeding and death rates were found to be highly significantly lower. -- Thus the investigated criteria for predicting a recent variceal hemorrhage are confirmed. Prophylactic sclerotherapy in esophageal varices with erosions and/or poor coagulation reserve of the liver can largely prevent an esophageal hemorrhage from varices, and prolongs the life of these chronically ill patients.