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• W2958908086 abstract "Potential conflict of interest: Nothing to report. To the Editor: I read with great interest the recent practice guidance on development of quality measures in cirrhosis.1 I commend the authors for producing a set of measures that will enable health care professionals and service providers to evaluate quality of care and drive improvement. I am, however, somewhat concerned by the inclusion of sclerotherapy in their process measure 11: “Patients with cirrhosis who are found to have bleeding esophageal varices should receive EVL or sclerotherapy at the time of index endoscopy.”1 Endoscopic band ligation was already shown many years ago to be associated with reduced mortality and fewer complications when compared with sclerotherapy. As far back as 1995, a meta‐analysis of seven trials comparing endoscopic band ligation with sclerotherapy in acute variceal bleeding showed a reduction of rebleeding from varices (odds ratio [OR] = 0.47, 95% confidence interval [CI] 0.29‐0.78), mortality (OR = 0.67, 95% CI 0.46‐0.98), and fewer esophageal strictures (OR = 0.10, 95% CI 0.03‐0.29). It has been stated that sclerotherapy for the treatment of variceal bleeding should be abandoned.2 The American Association for the Study of Liver Diseases guidelines clearly state that in variceal bleeding, endoscopic band ligation should be performed3 without any mention of sclerotherapy. Baveno VI guidelines state that band ligation is the recommended form of endoscopic therapy for acute esophageal variceal bleeding.4 The British Society of Gastroenterology guidelines very clearly state that sclerotherapy has been replaced by variceal band ligation and should no longer be offered as standard of care in acute variceal hemorrhage.5 Even if sclerotherapy may have a role in particular and unusual circumstances, as claimed by some, alternatives such as tissue adhesives and self‐expandable metal stents are likely to be of similar if not superior efficacy in such situations, without the risk of severe complications associated with the use of sclerotherapy. It certainly should have no role in the standard management of variceal bleeding. I believe this evidence should be reflected in any practice guidance, and sclerotherapy should not be included in any measures aimed at setting standards of care for patients with cirrhosis." @default.
• W2958908086 created "2019-07-23" @default.
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• W2958908086 date "2019-12-24" @default.
• W2958908086 modified "2023-09-26" @default.
• W2958908086 title "Letter to the Editor: The Obsolescence of Sclerotherapy" @default.
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• W2958908086 doi "https://doi.org/10.1002/hep.30853" @default.
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