The Use of Fibrin Glue in Sclerotherapy for Esophageal Varices: Preliminary Results of a Controlled Prospective Study

Abstract

In a randomized prospective study 26 patients with esophageal varices were treated after a first bleeding episode with either fibrin or polidocanol, both strictly injected intravariceal. Treatments were repeated until obliteration of varices, based on endoscopic and endosonographic evaluation, was achieved. Fourteen patients were treated with polidocanol and 12 with fibrin. There were no significant differences in stage of liver disease between the two groups. Complete variceal obliteration was achieved in six patients treated with polidocanol (42.8%) and nine patients in the fibrin group (75%). An average of 4 treatments with polidocanol and 5.2 treatments with fibrin was necessary. During therapy with polidocanol 11 episodes of rebleeding occurred in six patients. In the fibrin group only one patient suffered from two episodes of rebleeding. Esophageal ulcers caused by sclerotherapy were observed in 56.1% of polidocanol treatments and 8.7% of fibrin treatments. In neither group were changes of laboratory values or thrombembolic complications observed. These preliminary results show that it is possible to achieve a higher rate of obliteration with fewer complications using fibrin than with polidocanol. Therefore, we propose treating acute esophageal variceal bleeding with fibrin, especially in all patients with a higher risk of complications.