Clinical

Sclerotherapy should not be first-line treatment for variceal bleeding in cirrhosis

Last Updated: 2003-06-13 13:35:56 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Emergency sclerotherapy should only be used for cases of cirrhotic variceal bleeding that do not respond to treatment with vasoactive drugs, findings from a recent meta-analysis suggest.

Emergency sclerotherapy is widely used as a first-line therapy for such bleeding, but it remains unclear whether sclerotherapy is actually more effective than medical treatment.

To investigate, Dr. Gennaro D'Amico and colleagues, from the University of Palermo in Italy, conducted a meta-analysis of data from 15 trials that compared sclerotherapy with medical therapy as a treatment for variceal bleeding in cirrhosis. The outcome measures included failure to control bleeding, rebleeding, need for blood transfusions, adverse events, and mortality.

The researchers' findings are published in the May issue of Gastroenterology.

Sclerotherapy was no better than treatment with terlipressin, somatostatin, or octreotide for any of the outcome measures. For most outcomes, sclerotherapy was no better than vasopressin, but in one, potentially flawed study, sclerotherapy was tied to better bleeding control.

There was no evidence that sclerotherapy was safer than medical therapy, and some suggestion that it actually may be more harmful. For example, adverse events were significantly more common with sclerotherapy than with somatostatin. Similarly, more serious adverse events were noted with sclerotherapy than with terlipressin.

"Available scientific evidence does not support sclerotherapy as a first-line therapy in cirrhotic patients with variceal bleeding," the authors conclude. Given that banding ligation has similar results as sclerotherapy, they add, perhaps the current findings are also applicable to that modality.

Gastroenterology 2003;124:1277-1291.