Emergency sclerotherapy is not better than pharmacological therapy for acute variceal bleeding in cirrhosis

Variceal bleeding in cirrhosis is associated with a high risk of death. Although banding ligation of varices is considered the choice for endoscopic treatment, emergency sclerotherapy is frequently used particularly where ligation is not available or when it is not feasible. However, vasoactive drugs stop bleeding in most patients, and emergency sclerotherapy may carry risks to the patient and is more demanding on the health-care system. All of the identified randomised clinical trials comparing emergency sclerotherapy with vasopressin (+/- intravenous or transdermal nitroglycerin), terlipressin, somatostatin, or octreotide have been reviewed. A total of 17 randomised trials including 1817 patients were included. Sclerotherapy did not appear to be superior to the vasoactive drugs in terms of control of bleeding, number of transfusions, 42-day rebleeding and mortality, or rebleeding and mortality before other elective treatments. However, adverse events were significantly more frequent and severe with sclerotherapy than with vasoactive drugs.