A trial of elective versus on demand sclerotherapy in "poor risk" patients with variceal haemorrhage.

A prospective randomised trial of "planned" chronic injection sclerotherapy (at three weekly intervals) versus "demand" injection sclerotherapy (after variceal bleeds only) was performed in 40 patients who had endoscopically proven variceal bleeding, and who were either graded as modified Child's grade C or were more than 65 years of age. 45% of patients survived for one year and 37% for two years. There was no significant difference in survival between the groups at either one or two years (p < 0.5; p < 0.1). In the "planned" sclerotherapy group 24 gastrointestinal bleeds occurred in 11 patients over the first nine months after study entry. In the "demand" group 35 bleeds occurred in 13 patients over the first 18 months after study entry. In this small group of "poor risk" patients, planned chronic injection sclerotherapy was not associated with improved survival.