Long-term injection sclerotherapy for the primary and secondary management of variceal haemorrhage.

The beneficial effects of long-term sclerotherapy upon rebleeding from esophageal varices have been well established by several controlled trials, although the high frequency of early recurrent hemorrhage remains an important limitation. The beneficial effect of sclerotherapy on survival in such patients is less clear, but may also be concluded when the comparison is with control groups managed by conservative methods alone. The future probably lies with concepts of less intensive regimes of sclerotherapy. The evidence available with respect to prophylactic sclerotherapy is clearly conflicting. However, there is little to support the further use of this therapy in unselected groups of patients. Subsequent studies should be aimed specifically towards the selection of patients at high risk of first variceal hemorrhage, which might then be candidates more likely to benefit from prophylactic treatment.