Sclerotherapy for bleeding esophageal varices after randomized trials

Endoscopic sclerotherapy remains an uncertain therapy for bleeding esophageal varices. Several recently reported randomized trials address the efficacy of immediate, long-term and prophylactic sclerotherapy. Analysis of these studies suggests that sclerotherapy may stop acute bleeding but has little impact on survival of an acute bleeding episode. Ongoing sclerosis reduces the incidence of rebleeding episodes and improves survival for those patients fortunate enough to survive the acute bleeding episode. Prophylactic therapy is an exciting concept limited by difficulty in identifying 'high-risk' patients and by the high rate of complications associated with sclerotherapy.