Ultimate survival and outcome of treatment in this consecutive cohort of patients was disappointing. Although varices were eradicated in 82% of patients who survived more than 3 months, recurrent varices ultimately developed in 57% of patients, half of whom had further variceal bleeding. Several important and unresolved problems related to the role of repeated sclerotherapy in the long-term management of patients with esophageal varices remain. There is increasing recognition that an important limitation of long-term sclerotherapy is the substantial incidence of rebleeding, which is a particular feature of the early phase after endoscopic therapy has begun.24,28 The most common source of recurrent bleeding before variceal eradication in this study was from patent residual varices, which occurred in 31.7% of our patients. Urgent repeat endoscopy is essential since in 87.5% of patients with recurrent bleeding, varices were the source and were treated by sclerotherapy, which was effective in 113 variceal rebleeds in 91 patients. In 13 patients, a nonvariceal source of bleeding was identified. Serial sclerotherapy successfully eradicated esophageal varices in 80% of our patients. Although new varices formed following initial obliteration in 78 of 147 patients, this was associated with rebleeding in 45 of the 147 patients, which would support the validity of the concept of variceal eradication as a specific end point of treatment.
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