Sclerotherapy and esophageal variceal bleeding: time to forget it, or not?

Abstract

With great interest, we have read the article of Triantos et al. on evaluation of emergency sclerotherapy of varices [1]. Recently, the role of endoscopic injection sclerotherapy (EIS) has been challenged by endoscopic variceal ligation (EVL) and vasoactive drug therapy [2] [3], the latter being considered by many physicians to be the treatment of choice for patients with bleeding esophageal varices. Triantos et al. have questioned this interpretation [4], and we agree with them. In our opinion, EIS has been censured because is a technique that requires competence in endoscopy. By contrast, EVL is a simple technique with comparable results that does not require an experienced endoscopist. For this reason, the efficacy and safety of EIS are tied to the endoscopist, so there are wide variations in reported efficacy rates - the main reason is technique. On the basis of our experience, we know that a properly performed EIS needs paravariceal and intravariceal injection.