Endoscopic Esophageal Sclerotherapy: Long-Term Results of the Elective Procedure

Chronic endoscopic esophageal sclerotherapy represents a primary technique for the prevention of recurrent bleeding in cirrhotic patients who have already experienced one variceal bleeding episode. 131 patients with portal hypertension and a history of esophageal variceal bleeding underwent endoscopic sclerotherapy. 74 of these patients constituted a subgroup which was singled out for special analysis. In these patients, treatment had been started after conservative management of an acute bleeding episode had stopped the bleeding and follow-up data for at least 6 months were available. 90.5% of these patients had nonalcoholic etiology for their portal hypertension. 60.8% of patients developed recurrent varices and 11.1% had recurrent bleeding from esophageal varices. The bleeding risk index, calculated as the number of hemorrhages/patient/months of follow-up, correlated strongly with the number of previous hemorrhages and inversely with hepatic reserve (Child’s class). The bleeding risk index decreased tenfold after sclerotherapeutic obliteration of varices. These data suggest that chronic elective endoscopic sclerotherapy may play a primary role in the management of patients who have bled from esophageal varices.