Emergency endoscopic sclerotherapy for bleeding esophageal varices: a prospective study in patients not responding to balloon tamponade.

To assess the efficacy of endoscopic paravariceal sclerotherapy (EPS) compared to balloon tamponade, 25 patients with massive hemorrhage from esophageal varices not responding to Sengstaken or Linton tube tamponade were treated by emergency EPS. None of the patients had received vasopressin. Immediate control of hemorrhage was achieved in 92%. Recurrent bleeding occurred in 17.4% of patients during their primary admission. Minor complications resulting from EPS were observed in three patients (12%): esophageal ulcer, esophageal stenosis, and pleural effusion. Ten patients (40%) died in the hospital, seven of them despite arrested hemorrhage. Fifteen patients were discharged and followed at 3-month intervals for a mean of 21.3 months (range, 8.8 to 29.7). During this period one death due to liver failure without recurrent hemorrhage and three rebleeding events in two patients were observed (rebleeding risk per patient month, 9.4 x 10(-3). We conclude that EPS is very effective in controlling acute bleeding from esophageal varices, even in poor risk patients with ineffective balloon tamponade.