7224 Incidence of stricture formation, ulcer bleeding, perforation and massive hematoma formation from sclerotherapy versus band ligation of esophageal varices.

Abstract

BACKGROUND: Numerous complications have been reported with use of sclerotherapy (Scl)and with band ligation (BL) of esophageal varices. AIM: The aim was to compare the incidence of complications from esophageal variceal Scl and BL. Specific complications examined included: esophageal stricture formation, post Scl/BL ulcer bleeding, massive esophageal hematoma and esophageal perforation. METHODS: Consecutive EGDs in which Scl or BL were performed for either acute variceal treatment or subsequent obliterative therapy and entered into a computerized endoscopy database over a 7 year period were evaluated. Scl was performed with standard technique. BL was performed primarily with the Wilson-Cook Saeed 6 and/or 10 shooter. The choice to use Scl or BL was per the discretion of the endoscopist. Complications were assessed at scheduled follow up clinic and endoscopy visits, review of quality assurance data tallied on a monthly basis as well as patient records. RESULTS: 285 cases of Scl were performed in 95 patients (95M, mean age 57.1 yrs) compared to 102 cases of BL in 47 patients (94M:1F, mean age 55.8 yrs). For Scl sessions a mean of 5.8 injections were used to deliver a mean of 7.8 ml of sclerosant (range 0.5 ml to 27 ml). During BL 1 to 13 bands were placed (mean 4.7/case). Complications from Scl and BL are shown in Table below on a per patient basis. CONCLUSIONS: The incidence of complications from Scl of varices is much higher than that compared to BL with stricture formation incidence reaching statistical significance. Additional prospective multicenter follow up will be necessary to determine whether the incidence of ulcer bleeding, perforation and hematoma are truely different between BL and Scl. Per Patient Complications from Variceal Sclerotherapy or Band LigationSclerotherapy Band ligation p value Stricture 9.6% 2.1%