What is the Aim of Esophageal Variceal Sclerotherapy-Prevention of Rebleeding or Complete Obliteration of Veins?
Endoscopic variceal sclerotherapy (EVS) is highly effective in arresting active esophageal variceal bleeding. Subsequent repeated EVS sessions significantly reduce recurrence of bleeding; long-term survival is reported as prolonged or unaltered. In contrast, EVS for preventing first variceal bleeding (prophylactic sclerotherapy) is not recommended, even for high-risk patients, because it enhances mortality by significantly increasing the risk of bleeding in the treated group compared with controls. The risk of variceal rebleeding is maximum within 6 weeks of index bleeding; most patients who survive 6 weeks of variceal bleeding (with or without sclerotherapy) behave like patients who have never bled from varices. Thus, EVS continued beyond 6 weeks, to obliterate the veins completely, is akin to prophylactic sclerotherapy. Significant complications of EVS-its cost, discomfort to patient, and loss of doctor and patient time-should be weighed against doubtful benefit of continuing prolong
